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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

 

 

27-OCTOBER-2006  MUHAMED AHMAD BASALEEM  35 YEARS   HUGE  RECURRENCE L5-S1 WITH RIGHT  UP AND DOWNWARD MIGRATION.

The patient came to the emergency of Al-Shmaisani Hospital 27-October-2006 with agonizing pain with severe right sciatica for 10 days after lifting heavy object in YAR. MRI performed today showing a huge recurrence at L5-S1 with right up and downward migration. The patient was operated by me 4 years ago.

On examination: the patient had almost drop right foot with hypalgesia of right S1 territory. Positive cough sign. Other clinical examination was impossible to perform due to pain.

The patient was urgently taken to the operating room and right S1 foraminotomy was performed and the scar was removed from the right side and the extruded large disc material was removed in one piece. Inspection of the annulus fibrosis for remnants of extrusion was negative. The disc space was not violated intentionally.

Routine closure and smooth postoperative recovery.

Comments:

1. Considering that the extrusion was very huge and the disc space is shallow, the recurrence after such surgery must be minimal.

2. Second recurrence could have place in 7% of patients, how underwent second surgery for recurrence. This can happen if the same factors, which increase the recurrence for the first time, could play a role in triggering the recurrence the next time.

3. The cause of recurrence in this case was vigorous physical effort.  The operated disc patients must avoid such physical effort  for minimum 10 years.

 

 


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved