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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14-FEBRUARY-2010 AYSHEH SULAYMAN ALIYAN 60 YEARS
SEVERE LUMBAR CANAL STENOSIS L4-5 WITH EXTRUDED DISC LEFT UPWARD AND RIGHT
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The patient came to the
clinic 06-February-2010 complaining of LBP and
bilateral sciatica more the left
for 2 years. The patient cannot walk more than
On examination: the patient is
limping with exaggerated scoliotic stance . SLRS was
in both sides. The KJ
is absent in left side with weak dorsiflexion
4/5 of the right foot and almost drop left foot.
She had severe OA both knees without pain.
MRI lumbar spine requested and
done 09-February-2010 showing very severe lumbar
canal stenosis L4-5 with lesser degree at L3-4
with extruded disc L4-5 with left upward and
right downward extrusion..
Decompressive laminectomy of L4 and partial of
L3 and L5 with foraminotomy of both L5 roots.
The extruded disc was removed from both sides
and meticulous cleaning of L4-5 was
achieved from both sides. Using irrigation with
saline the friable fragments were removed from
the contralateral points of entry.
Satellite spinal system, was not necessary
the patient age and presence of stenosis.
Routine closure of the wound.
recovery, with normalization of the power of the right foot
and improvement of the power of the left foot..
The surgeon thinks
that he performed meticulous cleaning of the
disc space, but it is not true. It is impossible
to clean the disc space from even both sides, using the
Using irrigation with saline under pressure
increase the cleaning degree of loose disc
fragments and push the annulus fibrosis, making
possible to remove further intradiscal material,
as in this case.
presence of stenosis make insertion of PEEK
sphere impossible without violating the isthmus, for what
the idea of nucleus replacement device was
abandoned in this case.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .