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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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28-NOVEMBER-2011  AHMAD MUSTAFA AL-NADDAF  59 YEARS  EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.

Anamnesis

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The patient came to the clinic 16-Sepetember-2010 complaining of right sciatica for 4 years with sudden onset drop right foot for 2 months. The patient is a known diabetic for 9 years with arterial hypertension for 4 years. Stinting of coronary arteries was performed 2005.

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MRI lumbar spine performed 15-August-2010 showed bulge L4-5 and L5-S1. The patient was not limping nor has SLRS limitation with mild scoliotic stance. On examination: he had weak extension right hand and complete drop right foot with analgesia right L5 and hypalgesia right S1 roots. Considering the non-conformance  of the clinical and morphologic data, MRI of the brain with contrast , MRA brain , MRI lumbar spine with myelography were requested and showed complete occlusion of the right MCA  with scattered infarction both cerebral hemispheres with involvement of the left internal capsule. The patient was given medications to improve the post-stroke neural damage.

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The patient then came 16-November-2011 complaining of severe left sciatica for 2 months without LBP. The patient claim that the right foot improved and now is limping with exaggerated scoliotic stance. There is weak dorsiflexion left foot 4/5.

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The patient sent for new MRI lumbar spine, which showed extruded disc L5-S1 with left downward migration.

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Left S1 foraminotomy with partial flavotomy with preservation of the epidural fat. The extruded disc of L5-S1 was severely compressing the left S1 root. It was removed lateral to the axilla. Left sided cleaning of L5-S1 disc space. The hard extruded disc was missing from the field, for what bilateral cleaning of L5-S1 was achieved and the pushed to the contralateral side hard extrusion was removed from both sides.

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Smooth postoperative recovery with improvement of the power of  the 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 patient had downward migrating disc  compression of the root with hard disc, causing agonizing sciatica. If the piece was soft, no need for surgery, but the piece is hard in consistency and it will not shrink with time.

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The piece was fully separated from the annulus fibrosis, due to what it was shifted to the right side during exposure. It was attacked from both sides.

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The estimated postoperative recurrence is still around 7%, because the disc space is not shallow.

 


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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 .

 

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