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Dr. Ali Al-Bayyati and Dr. Munir Elias

 
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  neurosurgery.tv

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13-DECEMBER-2011  SAMIRA AMEEN AL-NASER  62 YEARS  LUMBAR CANAL STENOSIS L4-5 WITH WIDE BASED EXTRUSION.

Anamnesis

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The patient came to the clinic 03-November-2011 complaining of LBP with bilateral sciatica for 2 months more the right with numbness left hand for 5 months and ataxia for 9 years. The patient is a known hypertensive for 11 years and diabetic for 30 years in insulin.

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MRI lumbar spine done 21-October-2011 showing LCS L4-5.

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On examination, the patient has shuffling gait  and limping and unable to stand for Romberg positioning. There is weak upper limb muscles -4/5 with hypalgesia of the left median nerve territory. Hoffmann was positive in the left side with DTR  more brisk in the left side. SLRS was 80 degrees in both sides with pain with hypalgesia both legs below the knee with almost drop both feet and weak planterflexion both feet 4/5. 

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The patient was sent for investigations, which revealed PCD C4-5, 5-6 and MRI brain showing right IC old infarction.

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Extended 3/4 laminectomy of L4 and partial of L5. Bilateral foraminotomy. The facets were of kissing type  and the ligamentum flavum was adherent to the dura. It was sharply dissected to prevent tear of the later. The extruded disc was removed from both sides and the disc space was empty and shallow.

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Routine closure of the wound. Smooth postoperative recovery with improvement of the power of  both feet.


 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient had collapsed disc space of L4-5 with subsequent severe segmental stenosis.

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The estimated recurrence rate in this case is below 7% because the disc space is shallow.

 


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Notice: Head injuries and very urgent surgeries are also escaped from the plan .

 

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