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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23-JUNE-2008 SALWA MAHMOUD SALEH 43 YEARS
HUGE EXTRUDED DISC L3-4 CENTRAL WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 21-June-2008 with
LBP and left sciatica for 3 years with
exacerbation last 3 weeks and pain and numbness
left L4 territory.
MRI of the lumbar spine done
07-April-2008 showing huge extruded disc L3-4
central with left downward migration and small
extrusion of the L5-S1 disc left side.
On examination: the patient
is limping with exaggerated scoliotic stance.
SLRS was 60 degrees in the right and 70 degrees
in the left with pain. There is hypalgesia of
the left L4 territory with weak left quadriceps
4/5 and dorsiflexion left foot -4/5 and right
Using image-intensifier the
L3-4 level was identified and methyline-blue was
used as a marker. Laminectomy of L3 and partial
of L4 was performed with foraminotomy of both L4
roots was performed. Bilateral cleaning of the
disc space of L3-4 with removal of the extrusion
from both sides was done. Routine closure of the
Smooth postoperative recovery
and the power of both lower limbs improved.
The recurrence rate in this
case is below the average, because the disc
space is shallow and bilateral cleaning was
To decrease the bony
dissection, level acquisition by
image-intensifier is recommended, especially
when the level is high as L3-4 , as in this
Intentional neglect of L5-S1
was considered, because performing discectomy
for 2 levels will increase the recurrence rate
and the pain in the postoperative period bill be
retracted for several years.
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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 .