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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 16-July-2006 complaining right sciatica with hip pain with no scoliosis for one week. On examination: the motor and sensory functions were normal. The patient was operated by me 30.April-2006 for huge extrusion of L5-S1 right side. Despite the relatively acceptable condition of the patient, the patient was asked to perform check MRI to rule out recurrence. The patient took the decision to take pain killers and wait. 2 days later the right sciatica became more severe and the patient performed MRI, which confirmed the recurrence at the same site. On examination 18-July-2006, the patient was in agonizing pain with inability to stand with SLRS right 40 degrees and left 50 degrees with weak dorsiflexion right foot and hypalgesia right S1 territory.

The patient was operated the next day: right hemiscarotomy L5-S1 was performed and the recurrence was removed lateral to the axilla. After that, it was possible to dissect the right S1 root and inspect the axilla, which proved to be free of fragments. The root was severely involved with the scar process.

Prompt postoperative recovery and the power of the right foot became normal.

Comments:

1. The patient had at the first operation a huge extrusion and "meticulous" cleaning was performed. It is usually done when the annulus fibrosis defect is wide from the start.  The disc apse at the second operation was empty, but the disc material which came out and caused recurrence is mostly the parts of the annulus fibrosis and underlying external layers of the disc material.


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