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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

 

 

16-OCTOBER-2006  MARYAM ABDEL-GHANI AL-NATSHEH  38 YEARS  HUGE EXTRUSION L5-S1 WITH LEFT DOWNWARD MIGRATION.

The patient came to the clinic 12-October-2006  complaining of agonizing left sciatica for one month. She came 2002 with right sciatica and MRI was requested at that time but she escaped from the clinic. On examination, the patient could walk only with help with exaggerated scoliotic stance and she could not be able to take the supine position for examination.

On examination: SLRS was 5 degrees in the left and 45 degrees in the right with almost drop left foot with weak planterflexion. She had hypalgesia of the left L5 and S1 territories. MRI was asked and performed, showing very huge disc L5-S1 with left downward migration with lumbarization of the sacrum.

Bilateral S1 foraminotomy was performed and the huge extruded disc was removed lateral to the left S1 axilla was removed in one piece. Inspection of the right side was negative for remnants and inspection of the annulus fibrosis was glistening without presence of obvious defect. Considering that the disc space was narrow and the possibility for recurrence is low, it was decided not to perform intradiscal cleaning. Routine closure and smooth postoperative recovery.

Comments:

1. Considering that the extrusion was very huge and the disc space was narrow, the possibility for recurrence is low, for what the intradiscal space was not violated.

2. Intradiscal cleaning must be performed when the disc space is not narrow, even if the annulus fibrosis is glistening, because there are recurrences in such situation.

 

 


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved