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-MAY-2009 RAYED AHMAD AL-ZUUBY 32 YEARS
FOURTH RECURRENCE OF PLD L4-5 RIGHT SIDE.
The patient was operated by
me the second time
24-Novmber-2008 for the third recurrence at
L4-5 level right side. The patient was doing
well until he came 27-April-2009 complaining of
LBP with right sciatica for one week.
On examination: the patient
is limping with exaggerated scoliotic stance
with SLRS 30 degrees in
the right and 45 degrees in the left. There was
no weakness or hypalgesia.
The patient sent for new MRI
lumbar spine, which was done 28-April-2009 which
showed another recurrence in the right with soft
consistency component. The patient was given two
options: either to wait for 30-45 days until the
piece start to shrink or to undergo another
surgery. The patient could not tolerate the pain
and was admitted for surgery.
The wound was refreshed and
the most upper right corner was skeletonized.
Sharp dissection was proceeded medial to the
facet joint without violating the bony
structures. The extruded disc came under vision
and removed in several big pieces. Meticulous
cleaning of the intradiscal space of L4-5 from
the right until the disc space became empty.
Routine closure of the wound.
Smooth postoperative recovery
with disappearance of right sciatica.
The estimated recurrence rate
in this case is now must be zero, because the
disc space almost collapsed.
The patient got the 4th
recurrence which is rare, and the amount of the
disc material removed in this surgery hold the
possibility, that the disc material could
regenerate, because during every surgery a huge
amount was removed
It was not necessary to
expose all the neural structures. It was only
needed to reach the extrusion and remove it.
From that point of entry, further cleaning of
the disc space was performed.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .