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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

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Multigen RF lesion generator .

30-JANUARY-2010  ADNAN ISMAEEL JABER  40 YEARS  EXTRUDED DISC L5-S1 RIGHT SIDE.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis

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The patient came to the clinic 20-March-2003 complaining of suspected CSF leak which was ruled out. The patient then came 06-January-2010 complaining of low back pain for 1 year with right sciatica. Exacerbation of right sciatica the last month.

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On examination: the patient has scoliotic stance with SLRS 70 degrees with pain in the right with weal dorsiflexion both feet 4/5.

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MRI performed 06-January-2010 showing extruded disc L5-S1 huge central more to the right.

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Using the image-intensifier the L5-S1 level was identified and right hemiflavotomy L5-S1 with foraminotomy of right S1 root was performed. The extruded disc was removed lateral to the axilla and right sided cleaning of L5-S1 was done from the right.

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Using PEEK Satellite spinal system, it was necessary to use sphere No 13 to have acceptable prerequisites and check image-intensifier showed central location of the device.  The curette was not used intentionally, so as not to harm the endplate. Contrast was injected inside the disc space from the right. It was noted that the contrast media could not cross the right half to the left. Using feeding tube to inject the contrast to the left side also failed. It was noticed that the sphere is not moving from its position despite vigorous force applied, but it was only rotating at its bed.

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Routine closure of the wound.

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Smooth postoperative recovery, with improvement of the power of both feet.


Comments

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The surgeon think that he performed meticulous cleaning of the disc space. The use of contrast in this case was an illustration, that the disc remnants still there. Even the contrast could not fill the gap contra-lateral the excision and cleaning. This means, that there is still layers of the disc material behind the sphere.

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The diameter of the sphere is an indicator to the possible postoperative estimated recurrence . The more the diameter is parallel with the higher recurrence , in case of not using the sphere.


Back Up!

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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