Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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10-JULY-2008 JAMILA MUHAMED ALIA 64 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 07-July-2008 complaining of LBP
with left sciatica for four months with
exacerbation the last 2 days. The patient is
a known hypertensive patient.
On examination: the patient
in agonizing pain with scoliotic stance
with SLRS 80 degrees in the right and 50 degrees
in the left with pain. She
had weak dorsiflexion left foot 4/5 and
planterflexion left foot 4/5 with hypalgesia
left S1 root territory. She has severe OA both
The patient was sent for MRI
lumbar spine which was
performed 08-July-2008 showing PLD L4-5
with left downward migration compressing the
left L5 root. The patient has severe
osteoporosis, for what protelose was started.
because the patient has elements of
sacralization of L5, left L4-5 hemiflavotomy was
performed. Left L5 root foraminotomy was
achieved. The left L5 root was severely
compressed and adherent to the extruded disc. It
was necessary to clean the disc space of L4-5
from the left side so as to obtain some
redundancy to dissect the running root off the
extruded disc, which was removed in three
separate pieces. The root regained normal
appearance and the foramen was checked for
Routine closure of the wound
and smooth postoperative recovery with
normalization of the power of left foot.
The patient was in agonizing
pain due to severe root compression. She could
not sleep for the last week from pain.
The expected recurrence in
this case is around the average, because the
disc height still not shallow.
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Notice: Head injuries and very urgent surgeries are also
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