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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.fr

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19-NOVEMBER-2012  ABDEL-HALIM AHMAD NIMER  EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.

 

Anamnesis

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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.

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MRI of the lumbar spine done 03-October-2012 showing extruded disc L4-5 with left foraminal occlusion with bulge L5-S1.

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On examination: the patient using crutches for 2 months, is limping with exaggerated scoliotic stance. SLRS 30 degrees in the left with pain. There is drop left foot which the patient telling it had place for 4 months and hypalgesia left L5 and S1 territories.

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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. Control heamostasis.

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Routine closure of the wounds. Smooth postoperative recovery. The power of the left foot remain the same but the shooting sciatica disappeared.

 

 

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

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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. 

 

Leica HM500

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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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[2012] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved