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
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05-JULY-2012 ABDALLA MUHAMED AL-JABERY 62 YEARS
HUGE RECURRENT EXTRUDED DISC L3-4 WITH RIGHT DOWNWARD MIGRATION AND
The patient a Yemeni citizen came to the clinic
complaining of LBP for 4 months with bilateral
sciatica more the right.
patient is a known diabetic for 20 years and he
underwent surgery in Saudi Arabia 35 years ago
for an extruded disc L3-4.
spine done in Yemen 17-June-2012 showing huge
recurrence of L3-4 with right downward
examination, the patient is limping using
exaggerated scoliotic stance. SLRS was 90
degrees in the right
with weakness and 90 degrees in the left with pain. There is weak dorsiflexion right foot
-3/5 and planterflexion same foot 3/5 with
absent AJ both sides. Weak right quadriceps 3/5
and abduction both knees 3/5 and dorsi and
planterflexion left foot 3/5. There is
hypalgesia right L5 root territory. There is
brisk Babinski in the right side and
questionable one in the left.
patient was sent to MRI investigation, which was
done 01-July-2012 showing normal MRI of the
dorsal spine with extruded disc L3-4
with right downward migration with
retrolisthesis L3-4. Dynamic studies confirm the
instability of the retrolisthesis. Bone scan
showed only increase uptake of the left tibia at
the ankle due to old trauma. The patient had Hb
9.0 for what 1 unit of blood was given before
surgery and the another planned to be given
The old wound used with
slight extension upward to skeletonize the L3
and partial of L2. The L2-3 and L3-4 lateral
masses exposed until the transverse processes of
L3 and L4 were seen both sides. The right L4
root was identified after scarolysis and the
huge downward migrating recurrence was removed
from under axilla and the lateral to the axilla.
The disc space of L3-4 was cleaned from the
right side and TLIF cage 8x5x30 mm with bone
graft were inserted to the L3-4 disc space.
Using IsoBar Scientex pedicular screw system,
6.2x40 mm monoaxial screws were inserted to the
L4 body and 6.2x40 mm ployaxial screws were
inserted to L3 body. ISIS Inomed transpedicular
screw protocol was used and the root was
responding only to 4 mA. Using up to 15 mA DNS
did not got any response from the screws. Using
55 mm bended rods and two DLT straddler
connecting bars were used to fix the 2 rods by
40 mm connector. All stages of surgery were done
under image-intensifier control.
Routine closure of the wound. Smooth
postoperative recovery with dramatic improvement
of the power of both legs.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
The patient have several
problems which needs surgical correction. That
is the huge extrusion and the instability.
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 .