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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05-SEPTEMBER-2013 FATHI MUHAMED ABDEL-QADER 59
YEARS EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the clinic 04-September-2013
complaining of left hip pain for 3 months when
walking more than 300 meters. Exacerbation of
LBP with right sciatica and numbness of the
right foot with drop foot for 1 month. Using
crutches for 3 days.
MRI of the lumbar spine performed 20-August-2013
showing bulge L5-S1 with extruded disc L4-5 with
right downward migration.
On examination: the patient cannot walk or stand
with agonizing sciatica. He is using drop foot
brace right foot for 4 days. The patient is
limping with exaggerated scoliotic stance. There
is drop right foot with hypalgesia right L5 root
territory. SLRS was 60 degrees in the right with
Considering the patient has
lumbarization of the S1, the C-arm was used to
identify the L4-5 level. Laminectomy of L4 and
upper fifth of L5 was done. Foraminotomy of the
right L5 root. The root was severely compressed
by the extrusion and surrounding bony and soft
tissues elements. The extruded downward
migrating disc fragments were removed lateral to
the axilla. Right sided intradiscal cleaning of
L4-5 disc space.
recovery. The power of the right foot still the
The patient still have an estimated
postoperative recurrence around 7% because the
disc space height still not shallow.
When complete drop foot take place for several
days before surgery, recovery will be partial
and extend for several months.
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