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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18-MAY-2010 ARHAM SULAYMAN AL-SABER 55 YEARS
EXTRUDED DISC L4-5 WITH FAR DOWNWARD MIGRATING DISC TO THE RIGHT L5 ROOT CANAL.
to the clinic 15-May-2010 complaining of LBP
with right sciatica for one month down to the
right L5 territory with numbness of the big toe
MRI lumbar spine
performed 06-May-2010 showing extruded disc L4-5
with separated far downward migration to
direction of the right L5 root.
On examination the
patient is limping with exaggerated scoliotic
stance with SLRS 80 degrees with pain in the
right. There is weak dorsiflexion 3/5 and
planterflexion 4/5 of the right foot with
hypalgesia below the right knee.
foraminotomy of the right L5 root was done to
around 15 mm over the root trying during that
not to violate the isthmus and drilling with
high speed, so as not the case surgical trauma
to the compressed root. The far migrating piece
was pushing the compressed root medially. This
fragment was removed in several pieces after
what the root became lax and voluminous. Partial
flavotomy was achieved to reach the L4-5 disc
level up and further cleaning of the disc space
of L4-5 was performed lateral to the axilla.
Smooth postoperative recovery with normalization
of the power of the right foot..
The patient had
separated fragment migrating down far with the
right L5 root. IT was her main problem. If
standard discectomy was performed without paying
attention to this fragment which was 5 mm down
the inferior edge of the disc level, the patient
will continue to complain of the same complains
In this case the disc space
still not shallow, and the estimated recurrence
rate will be around 7%.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .