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Munir Elias 20-12-2013
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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.tv

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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.

Anamnesis

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The patient came 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 right foot.

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MRI lumbar spine performed 06-May-2010 showing extruded disc L4-5 with separated far downward migration to direction of the right L5 root.

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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.

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Extended 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.

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Smooth postoperative recovery with normalization of the power of the right foot..


Comments

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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 after surgery.

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In this case the disc space still not shallow, and the estimated recurrence rate will be around 7%.

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