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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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Multigen RF lesion generator .

25-AUGUST-2011  FALHA AL-HRAYER AL-RWELY  45 YEARS  EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.

Anamnesis

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The patient came to the clinic 21-October-2009 complaining of LBP and bilateral sciatica for 6 months with difficult standing. MRI lumbar spine performed 10-October-2009 showing bulge L4-5. SLRS was 45 degree in the left with weak dorsiflexion both feet 4/5. The patient had several complains for what MRI of the brain cervical and dorsal spine were performed 22-October-2009 , which showed small PCD C5-6 and chronic sinusitis and empty sella. The patient was advised to continue in conservative treatment.

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The patient then came 22-August-2011 complaining of LBP for 4 months with left agonizing sciatica for the last 2 weeks.

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On examination: the patient is limping with exaggerated scoliotic stance. There is weak dorsiflexion left foot -3/5. SLRS was 50 degrees in the left side with pain. There is diffuse papular skin eruption for several days all over the body, mostly chickenpox, which the relatives are telling that it is now an epidemic in their local area in Al-Jawf in Saudi Arabia, for what antibiotics were started immediately.

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MRI lumbar spine was done 24-August-2011 showing extruded disc L4-5 with left foraminal occlusion, for what surgery was advised.

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Left L5 root foraminotomy done. Left hemiflavotomy L4-5 achieved. The extruded disc was removed from under the axilla in one big piece. Left sided cleaning of the L4-5 disc space.

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Routine closure of the wound.  Smooth postoperative recovery  with improvement of the power of left foot.


 

 

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

Comments

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The estimated recurrence in this case is around 7% because the disc space is still not shallow.

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The huge fragment under the axilla was the cause of the agonizing sciatica.

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The Al-Jawf area must be re-evaluated for chickenpox epidemy.

 

 

 

 


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