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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

 

20-AUGUST-2006  MAJIDAH JAMAL ABDEL-MAJEED  43 YEARS  RESIDUAL AFTER SEVERAL OPERATIONS FOR RECURRENT PLD L4-5 AND DE NOVO PLD L3-4 

The patient came 05-August-2006 complaining of left sciatica the last month progressed to bilateral sciatica the last week more to the right and urgency with frequency. MRI of the lumbar spine done 03-August-2006 showed a huge PLD L3-4. The patient was operated for recurrent disc L4-5  22-May-2005.

On examination: the patient was limping with SLRS 10 degrees both sides with weak planter and dorsiflexion both feet. Hypalgesia both lower limbs below the knee.

Bilateral flavotomy with bilateral foraminotomy both L4 roots was achieved. The extruded disc was attacked from the right and it was removed in one piece. Bilateral cleaning of the disc space and check of the roots for presence of any extrusions was done. Meticulous cleaning of the disc space was performed, since the defect in the annulus fibrosis was wide.

Comments:

1. In case of presence of central huge disc as in this case, to minimize the traction injury, it is preferable to perform intradiscal cleaning, then tract the extrusion to the intradiscal space and from there, remove it. By this means, the level of surgical trauma must be minimized.

2. Bilateral cleaning is a must in this case to avoid missing pieces.


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