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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



The patient came 20-August-2006 complaining of left sciatica the last month with numbness and pain in the left S1 root territory. MRI of the lumbar spine performed 29-July-2006 showing huge extrusion L5-S1 with left downward migration.

On examination; the patient in agonizing pain with scoliotic stance and limping. SLRS was 45 degrees in the left with pain, hypalgesia left S1 root and weak dorsi and planterflexion left foot.

Left S1 foraminotomy was performed with partial left hemiflavotomy. The extruded disc  removed in 2 separate pieces from under the axilla, after what the root regained relaxed position. Inspection of the annulus fibrosis lateral to the axilla showed pin-point defect and relatively glistening surface, for what it was decided not to violate the disc space.


1. In this case only the extruded piece was removed and the disc space was not violated because the defect in the annulus fibrosis practically was not visible. Time will tell if such strategy will diminish the rate of recurrence.

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