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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18-NOVEMBER-2009 MUUMEN GHULAM AL-SAMERAEE 20
YEARS EXTRUDED CENTRAL DISC MORE TO THE LEFT L4-5.
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came to the clinic 11-November-2009 from Iraq
complaining of LBP with left sciatica for 7
months down to L5 territory.
MRI lumbar spine performed
09-November-2009 showing extruded disc L4-5
central more to the left with downward
The patient was
limping with exaggerated scoliotic stance. SLRS
35 degrees in the right and 30 degrees in the
left. He had weak dorsiflexion both feet 4/5
right and 3/4 left side with hypalgesia left L5
and S1 territories.
Left L4-5 hemiflavotomy with
exposure of the compressed left L5 root. There
epidural fat due to severe compression. Using
image-intensifier during all steps of surgery
the level of L4-5 was confirmed and the extruded
disc was removed lateral to the axilla of left
L5 root. Meticulous cleaning of the disc space
of L4-5 was achieved from the left. The root
from the begging of the surgery had small tear
in the most lateral aspect without CSF leak
which was left until the end of the surgery.
PEEK Satellite nucleus
replacement sphere No 12 was inserted and check
in AP and lateral views was done confirming
acceptable position of the device.
The dural defect which was 1
mm length was stitched using one stitch of 6
zero nylon. Check for CSF leak while putting the
head of the patient high and using Valsalva
maneuver was negative for CSF leak.
Routine closure of the wound
and smooth postoperative recovery and
improvement of the power of both feet.
Recurrence of disc prolapse
is around 15% in this case because the disc
space is still high and the defect of the
annulus fibrosis is wide.
To minimize this to 2%, PEEK
Satellite nucleus replacement sphere was
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 .