www.neurosurgery.tv 
   
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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 to the clinic with complains of right sciatica and numbness of the left foot with inability to walk more than 100 meter. MRI performed 18 months ago showed huge PLD L5-S1. On examination, the patient had bilateral drop feet with sciatica more pronounced in the right side and hypalgesia both L5 and S1 roots. Repeat MRI showed the same picture.

Bilateral L5-S1 flavotomy with bilateral foraminotomy of both S1 roots was performed and the extrusion was removed from both sides and cleaning of the disc space was done from both sides. It was interesting that the disc material was migrating behind the cul de sac from the right side and this part was removed from the epidural fat behind the right S1 root.

Comment:

Here is a case, that minimal cleaning of the disc space is impossible, because all the time the disc material was coming from the disc space and it was impossible to leave fragments in the space. In the other side, attempt was made to preserve the integrity of the lateral wall of the annulus fibrosis, to prevent possible collapse of the disc space. It is the second case in the same day rising the challenge, that the concept of trying to leave as much as possible in the intradiscal space to prevent future collapse. The conclusion that, this task is hard to achieve in very huge extrusion of the disc material with bilateral extrusion.

 


  

[2005] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved