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Dr. Ali Al-Bayyati and Dr. Munir Elias

 
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

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20-JANUARY-2012  AFAF IBRAHEEM ABBAS  51 YEARS  RECURRENT DISC L5-S1.

Anamnesis

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The patient was operated by me 03-January-2012 for wide-based extruded disc L5-S1. The patient the third postoperative day started to complain of agonizing right sciatica which continued to escalate the following days.

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Check MRI of the lumbar spine was performed 19-January-2012 confirming the presence of recurrence at the same level with a hard piece separated from the disc space at the right S1 axilla. Considering that the patient is in agonizing sciatica she was planned for revision.

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The wound was opened and the right S1 root was surrounded by massive inflammatory fibrotic tissues. Scarolysis was done and the root was swollen. Annulotomy was performed lateral to the root and subaxillary, until the root was free of any compression. Inspection around the root was negative. A hard annulus fibrosis fragment was stuck to the dura medial to the axilla. It was sharply dissected from the dura. Using high-speed drill the bony edges of the upper border of S1 and lower border of L5 was drilled out from the right 2/3 of the area, so as to ensure that no annulus remnants were left behind. Further inspection of the area confirmed no presence of any fragments left behind intra, extradural or inside the swollen root.

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Routine closure of the wounds. Smooth postoperative recovery with decrease of the right sciatica.


 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient still having recurrence rate below 7% because the disc space is slightly shallow, even with annulotomy performed.

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The swollen root me play a role in pain generation. The postoperative course will give the answer.

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Here, it is not a true recurrence, but the hard piece of the annulus fibrosis, stuck to the dura gave the false impression of recurrence. The agonizing sciatica enforced for reoperation.

 


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