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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15-JUNE-2009 RAAED MAHMOUD AL-HAMOURY 37
YEARS EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 22-April-2009 complaining of LBP for 5
years with left sciatica the last 9 months with
exacerbation of sciatica the last month.
On examination: the patient
was limping with weak dorsiflexion left foot 4/5
and exaggerated scoliotic stance. SLRS was 30
degrees with pain in the left with absent AJ in
MRI lumbar spine, which was
done 22-April-2009 showed extruded disc L4-5 with
The patient was advised to
undergo surgery, but he disappeared.
The patient then came
10-June-2009 claiming that he improved but
clinically and morphologically was the same as
confirmed in the MRI performed 08-June-2009.
Using image-intensifier, the
L4-5 level was identified. Left L5 foraminotomy
was performed after reflection of the ligamentum
flavum to the right. The old extruded disc was
removed lateral to the axilla and meticulous
cleaning of L4-5 disc space was achieved from
the left. A flap with pedicle of surrounding fat
was transferred to the root to minimizes the
scar formation and the ligamentum flavum was
place back in position.
Smooth postoperative recovery
with improvement of the power of the left foot.
The patient still having
considerable height of the disc space, which
make the expectation of recurrence higher than
So as to avoid dramatic
clinical deterioration in case of possible
recurrence the foraminotomy was extended more
down to have ample to the root in case of
recurrence. The defect in the annulus fibrosis
also was opened more laterally to make the
theoretically proposed recurrence go lateral to
the running root.
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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 .