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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25-FEBRUARY-2008 HASAN RAGHEB AL-QARANDAS 65 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 19-November-2007 complaining of LBP for
two years with left sciatica. The last three
months got right sciatica, then left sciatica.
09-September-2007, showed dehydration of L3-4,
L4-5 and L5-S1 with small extruded disc L4-5
with left downward migration.
The patient was limping with
scoliotic stance and had almost drop left foot.
The patient was sent for another MRI of the
lumbar spine, which was performed
22-November-2007 confirming the presence of the
downward migration and foraminal occlusion left
Left L4-5 hemiflavotomy was
performed and foraminotomy of left L5 root was
achieved. The extruded disc under the root was
identified and removed in piece-meal fashion,
after what the root became lax.
The disc material was old and sequestrated and
part of it was adherent to the root, for what,
so as to avoid tear of the root adhesions were
left in place in the anterior portion of the
root above the level of DRG.
Left sided cleaning of the
disc space of L4-5 was performed. The disc space
was not shallow.
Routine closure of the wound
and smooth postoperative recovery.
The patient had considerable disc
space height, which make the estimated recurrence
around the average - 7%.
The extruded disc was
compressing the root, for what an agonizing pain
was the prominent feature in her clinical
picture. The morphologic changes of the root
were an old one and there was a lot of adhesions
with root. This could lower the rate of
functional recovery. Despite this fact, the
motor function recover immediately, but the pain
pathways could remain for long time especially
the pseudoradicular type.