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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

 
The patient came to the clinic 22-February-2006 complaining of right sciatica for 2 months with positive cough sign down to S1 territory. MRI done 2 days ago showed extruded disc L5-S1 with right downward migration with bulge L4-5 disc.

On examination, the patient was limping with SLRS 30 degrees in the right, hypalgesia right L5 territory with weak planter and dorsiflexion right foot. The patient was advised to undergo surgery, but he escaped.

The patient came 29-April-2006 urging for surgery, because his pain escalate, that he could not sleep for 5 nights. The patient was sent for another MRI, which showed the same picture.

Right L5-S1 hemiflavotomy with S1 root foraminotomy was done and the extrusion was removed lateral to the axilla. Meticulous cleaning of the disc space was done from the right side. A tube was inserted to the disc space and irrigation of the disc space did not gave any further disc material due to smallness of the hole, which intentionally was small. The volume of water which was injected to fill the cavity was 1 ml. It was replaced with gentamicin. Routine closure of the wound

Comments:

1. This last procedure gave a new idea to decrease the incidence of recurrence. Neuroendoscope will replace the this tube to perform multiple or one wide defect in the anterior wall of the annulus fibrosis under direct vision, to make the inside migrating disc material more liable to slip anteriorly, decreasing by this way the recurrence rate. This is a plan for the near future.


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