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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13-MAY-2009 AMNEH MUHAMED ABU-SALAH 42 YEARS
HUGE EXTRUDED DISC L5-S1 LEFT SIDE.
The patient came to the
clinic 05-May-2009 complaining of left sciatica
for 45 days down to the left S1 territory with
positive cough sign. The patient is recently
diagnosed diabetic, but in no medication.
MRI Lumbar spine performed
12-April-2009 showing huge extruded disc L5-S1
with up and downward migration.
On examination: the patient
is limping with exaggerated scoliotic stance
with SLRS 30 degrees in
the left and weak dorsi 2/5 and planterflexion left
foot -4/5. There is hypalgesia left S1 territory
Foraminotomy of left S1 root
with reflection of ligamentum flavum to the
right and stay stitch was applied to reflect the
flaval flap to the right. The
extruded disc was severely compressing the root
and the root was severely swollen and immovable. The disc space was shallow and cleaning
of the disc space of L5-S1 was performed from
the relatively wide defect in the annulus
fibrosis. The extruded disc of L5-S1 was
partially removed lateral to the axilla.
Considering that the root is swollen and the
extruded material was not adequate in quantity,
comparing with the MRI data, check
image-intensifier was applied and the level was
right. Further inspection of the root was
performed and the huge upward migrating disc
pieces was possible to remove only from under
the axilla? The ligamentum flavum was reflected
back to cover the exposed root.
Smooth postoperative recovery
with normalization of the power of the left
The estimated recurrence rate
in this case is below 7% since the disc space is
shallow, but the defect in the annulus fibrosis
The patient is diabetic, for
what monopolar coagulation was avoided to
prevent thermal trauma to the tissues, so as, to
decrease the possible post-operative rate of
The ligamentum flavum was
reflected to the right and after performing the
surgery, it was retuned back to minimize the
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