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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

 
19-AUGUST-2006  KHALED IBRAHEEM MUHAMED  33 YEARS  RECURRENT PLD L5-S1 LEFT SIDE.  
The patient came 16-August-2006 complaining of LBP for 8 months  with left sciatica. MRI done which is missing and according to that , he was operated 02-April-2006 elsewhere for PLD L5-S1, after what the patient claiming that his condition deteriorated and he was in bed for 21 days with progression of deep venous thrombosis "DVT"  of the left lower limb 2 weeks after the operation.

MRI performed 17-July-2006 showing the "recurrence " of L5-S1 with left downward migration. On examination: the patient has still DVT of the left lower limb with agonizing left sciatica, hypalgesia of left L5 and S1 roots territories. He had weak dorsi and planterflexion of the left foot.

The patient was covered with clexane 40 mg /day before surgery to prevent the escalation of DVT and was operated.  Using the old scar, which was very low, it was impossible to performed the operation, for what the skin incision was extended high. Skeletoniztion of L5 lamina and the upper edge of the sacrum, which was full of adhesions.  The left side of the L5 lamina was drilled partially to expose the normal dural sheet. Foraminotomy of the left S1 root was performed to expose the normal looking neural structures. The bleeding due to clexane made the dissection very difficult. It was necessary to expose S1 and S2 to be sure about the normal anatomy. The medial part of the left L5-S1 facet was drilled to gain direct access parallel to the scarous running root. The extruded disc material was stuck to the dura and intermingled with the scar. Piece-meal resection of the extrusion and the scar was performed from the healthy looking parts until the root became free of the scar and the extrusion. Meticulous cleaning of the disc space from the left side lateral to the axilla. Inspection under the axilla was negative. Inspection of the S1 and S2 roots at their foramina ruled out any compression. Routine closure. Prompt postoperative recovery.

Comments:

1. Using clexane  24 hours before surgery with the dose 40 mg made the operation, very difficult. Even the scar was diffusely oozing, mandating continuous bipolar coagulation and heamostasis with irrigation of saline. Most of the time was spent to identify the neural structures and to continue working with confidence, so as to avoid damage to the already damaged neural structures.


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