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The group in action.

 
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

 
28-JUNE-2006 ABDEL-HAMEED MUTI DA'AAS 38 YEARS HUGE BILATERAL EXTRUSION OF L3-4 DISC
The patient came to the clinic 25-June-2006 complaining of LBP for 3 years after falling down with right sciatica. Exacerbation of LBP with bilateral sciatica the last 15 days more the right with positive cough sign.

MRI lumbar spine done 08-June-2006 showing huge extrusion L3-4 with small bulge L4-5. The extrusion is more in the right side in the upper corner with left downward migration.

On examination, the patient has dripping urine for 14 days, limping and unable to lay supine for examination, with scoliotic stance. SLRS was unable to perform due to pain with absent KJ in the right. The patient had cauda equina syndrome with weak dorsi and planterflexion right foot.

Using image intensifier, the L3-4 was identified and with methylin-blue the level was marked. Bilateral L3-4

LBP for 3 years after falling down with right sciatica. Exacerbation of LBP with bilateral sciatica the last 15 days more the right with positive cough sign.

MRI lumbar spine done 08-June-2006 showing huge extrusion L3-4 with small bulge L4-5. The extrusion is more in the right side in the upper corner with left downward migration.

On examination, the patient has dripping urine for 14 days, limping and unable to lay supine for examination, with scoliotic stance. SLRS was unable to perform due to pain with absent KJ in the right. The patient had cauda equina syndrome with weak dorsi and planterflexion right foot.

Using image intensifier, the L3-4 was identified and with methylin-blue the level was marked. Bilateral L3-4 was performed and bilateral foraminotomy. First the right upper corner of the exposure was prepared and a huge extrusion was removed lateral to the axilla. The right root became relaxed, but the other side still tight. Another huge extrusion was removed from the left side and bilateral cleaning of the disc space was performed after what both roots became lax and redundant

 was performed and bilateral foraminotomy. First the right upper corner of the exposure was prepared and a huge extrusion was removed lateral to the axilla. The right root became relaxed, but the other side still tight. Another huge extrusion was removed from the left side and bilateral cleaning of the disc space was performed after what both roots became lax and redundant. Routine closure of the wound.

Smooth postoperative recovery.

Comments:

1. Do not ever be satisfied with the removal of huge piece of extrusion from one side. Inspect the other side, as in this case, an even bigger piece can be hidden in the other side.

2. Good inspection of both roots is mandatory when the patient has cauda equina syndrome and bilateral foraminotomy is a must.


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