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-JUNE-2009 SHAMSIYEH ABDALLAH YOUSEF 66 YEARS
EXTRUDED DISC L4-5 WITH SEGMENTAL STENOSIS AND COMPLETE OBLITERATION OF THE LEFT
The patient came to the
clinic 20-June-2009 complaining of LBP and left sciatica
for one week. The patient is a known
hypertensive and diabetic.
On examination: the patient
was limping with exaggerated scoliotic stance
and weak dorsiflexion both feet 4/5 more the
left . SLRS was 80 degrees with pain in the
MRI lumbar spine performed
20-June-2009 showing extruded disc L4-5 with
left foraminal occlusion and secondary severe
segmental stenosis at this level.
Laminectomy of L4 and upper
edge of L5 was performed. Bilateral foraminotomy
of L5 roots was achieved. The extruded disc was removed
lateral to the axilla and meticulous cleaning of L4-5
disc space was achieved from the left lateral to
the axilla. There was a remnant of epidural fat
in the right side which was shifted to the left
L5 root to minimize the scar formation over it. Routine
closure of the wound
Smooth postoperative recovery
with improvement of the power of both feet.
The patient still having
considerable height of the disc space, which
make the expectation of recurrence around 7%.
So as to avoid dramatic
clinical deterioration in case of possible
recurrence the foraminotomy was extended more
down to have ample to the root in case of
recurrence and the stenotic elements were
eliminated all over.
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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 .