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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11-NOVEMBER-2008 AKRAM ABDEL-RAHEEM SULAYMAN 43
YEARS CENTRAL EXTRUDED DISC L4-5 WITH LEFT UPWARD MIGRATION.
The patient came to the
clinic 20October-2008 complaining of LBP for 7
years. Exacerbation of LBP with Left
sciatica the last month with intermittent
claudication when walking 100-150 meters.
MRI lumbar spine performed
10-October-2008 showed huge extruded disc L4-5
central more to the left with upward migration.
On examination: the patient
is limping with exaggerated scoliotic stance,
with SLRS 75 degrees in the right and 80 degrees in left side with pain and
weak dorsiflexion left foot -4/5 and
4/5 right foot.
The patient has bronchial
asthma and he was given prednisolone 20 mg
twice daily for 10 days. He was told to stop it.
The patient has also
laminectomy of L4 and L5 was performed.
Foraminotomy of left L5 root was achieved. Left
L4-5 hemiflavotomy was done. The extruded disc
L4-5 was attacked lateral to the left axilla.
Meticulous cleaning of L4-5 was performed,
trying during that, not to enlarge the defect in
the annulus fibrosis. The root became lax.
Routine closure of the wound.
Smooth recovery with prompt
improvement of the power of both feet.
The patient had an extruded
centrally located disc more to the left. It was
causing secondary segmental canal stenosis. The
extrusion was old and the clinical
manifestations were a mixture of stenosis and
radiculopathy. Both elements must be corrected
The estimated recurrence rate
in this case is around 7% since the disc space
height is still not shallow, despite the fact
that the defect in the annulus fibrosis was
minimal, in the hope to lower the estimated rate
Gilbert's disease is a benign
one but anesthesia must be considered to prevent
liver drug interactions. At the same time
bronchial asthma also must be taken into
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