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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25-AUGUST-2011 FALHA AL-HRAYER AL-RWELY 45 YEARS
EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.
Anamnesis
The
patient came to the clinic 21-October-2009
complaining of LBP and bilateral sciatica for 6
months with difficult standing. MRI lumbar spine
performed 10-October-2009 showing bulge L4-5.
SLRS was 45 degree in the left with weak
dorsiflexion both feet 4/5. The patient had
several complains for what MRI of the brain
cervical and dorsal spine were performed
22-October-2009 , which showed small PCD C5-6
and chronic sinusitis and empty sella. The
patient was advised to continue in conservative
treatment.
The
patient then came 22-August-2011 complaining of
LBP for 4 months with left agonizing sciatica
for the last 2 weeks.
On
examination: the patient is limping with
exaggerated scoliotic stance. There is weak dorsiflexion
left foot
-3/5. SLRS was 50 degrees in the left side with
pain. There is diffuse papular skin eruption for
several days all over the body, mostly
chickenpox, which the
relatives are telling that it is now an epidemic
in their local area in Al-Jawf in Saudi Arabia,
for what antibiotics were started immediately.
MRI lumbar
spine was done 24-August-2011 showing extruded
disc L4-5 with left foraminal occlusion, for
what surgery was advised.
Left L5 root foraminotomy
done. Left hemiflavotomy L4-5 achieved. The
extruded disc was removed from under the axilla
in one big piece. Left sided cleaning of the
L4-5 disc space.
Routine
closure of the wound. Smooth postoperative
recovery with improvement of the power of
left foot.
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Comments
The estimated recurrence in this case is around
7% because the disc space is still not shallow.
The huge fragment under the axilla was the cause
of the agonizing sciatica.
The Al-Jawf area must be re-evaluated for
chickenpox epidemy.
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 .
