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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19-NOVEMBER-2012 ABDEL-HALIM AHMAD NIMER EXTRUDED
DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.
The patient came to the clinic 19-November-2012
complaining of LBP and left sciatica 2005 which
was treated conservatively. 4 months ago got
exacerbation of the LBP with left sciatica with
agonizing pain with numbness of the big toe left
foot. The patient performed epidural block
without any benefit 1 week ago.
MRI of the lumbar spine done 03-October-2012
showing extruded disc L4-5 with left foraminal
occlusion with bulge L5-S1.
On examination: the patient
using crutches for 2 months, is limping with
exaggerated scoliotic stance. SLRS 30 degrees in
with pain. There is
drop left foot which the patient telling it had
place for 4 months and hypalgesia
left L5 and S1 territories.
Left L4-5 hemiflavotomy with
foraminotomy left L5 root. The extruded disc was
severely compressing the nerve. It was removed
piece by piece lateral to the axilla. Most of
its part was removed after decompressing the
disc space and pushing down the extrusion to the
disc space and subsequent removal of the big
piece. After that the root became lax and
movable. Meticulous cleaning of the L4-5 disc
space from the left. The patient was bleeding
all the time and the epidural bleeder was
controlled by muscle piece in the upper corner.
Routine closure of the wounds. Smooth
postoperative recovery. The power of the left
remain the same but the shooting sciatica
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The patient still has an
estimated postoperative recurrence around 7%,
because the disc space is still not shallow.
When drop foot remain for several months it is
highly unexpected to see rapid recovery of the
motor function. Recovery will take several
months to be achieved.
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