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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28-NOVEMBER-2011 AHMAD MUSTAFA AL-NADDAF 59 YEARS
EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
The
patient came to the clinic 16-Sepetember-2010
complaining of right sciatica for 4 years with
sudden onset drop right foot for 2 months. The
patient is a known diabetic for 9 years with
arterial hypertension for 4 years. Stinting of
coronary arteries was performed 2005.
MRI lumbar
spine performed 15-August-2010 showed bulge L4-5
and L5-S1. The patient was not limping nor has
SLRS limitation with mild scoliotic stance. On
examination: he had weak extension right hand
and complete drop right foot with analgesia
right L5 and hypalgesia right S1 roots.
Considering the non-conformance of the
clinical and morphologic data, MRI of the brain
with contrast , MRA brain , MRI lumbar spine
with myelography were requested and showed
complete occlusion of the right MCA with
scattered infarction both cerebral hemispheres
with involvement of the left internal capsule.
The patient was given medications to improve the
post-stroke neural damage.
The
patient then came 16-November-2011 complaining
of severe left sciatica for 2 months without
LBP. The patient claim that the right foot
improved and now is limping with exaggerated
scoliotic stance. There is weak dorsiflexion
left foot 4/5.
The
patient sent for new MRI lumbar spine, which
showed extruded disc L5-S1 with left downward
migration.
Left S1 foraminotomy with partial flavotomy with
preservation of the epidural fat. The extruded
disc of L5-S1 was severely compressing the left
S1 root. It was removed lateral to the axilla.
Left sided cleaning of L5-S1 disc space. The
hard extruded disc was missing from the field,
for what bilateral cleaning of L5-S1 was
achieved and the pushed to the contralateral
side hard extrusion was removed from both sides.
Smooth postoperative
recovery with improvement of the power of
the left foot.
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Comments
The patient had downward migrating disc compression of the
root with hard disc, causing agonizing sciatica.
If the piece was soft, no need for surgery, but
the piece is hard in consistency and it will not
shrink with time.
The piece was fully separated from the annulus
fibrosis, due to what it was shifted to the
right side during exposure. It was attacked from
both sides.
The estimated postoperative recurrence is still
around 7%, because the disc space is not
shallow.
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 .
