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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09-SEPTEMBER-2013 FERYAL SALEH HALAWAH 68 YEARS
EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.
Anamnesis
The patient came to the clinic 17-June-2013
complaining of LBP with left sciatica for 4 months down to
all toes left
foot with numbness. She is a known diabetic with
glucophage 850 mg once or twice for 2 years.
MRI of the lumbar spine performed 21-April-2013
showing extruded disc L4-5 with
left foraminal occlusion and bulge L5-S1.
On examination: the patient is
limping with exaggerated scoliotic stance. There
is weak dorsiflexion left foot 3/5. SLRS was
65 degrees in the left with pain. The patient
was advised to undergo surgery, but she escaped.
The patient then the last three days got an
agonizing sciatica, that she was urging for
surgery.
Using C-arm, the level of
L4-5 identified. L4-5 flavotomy with right L5
foraminotomy was done. The epidural fat and the
ligamentous structures were swollen as having
inflammatory process. The extruded disc was
friable and involved in inflammatory process, removed lateral to the axilla of the right L5
root. Right sided cleaning L4-5 disc space. The
disc material was sent for CXS.
Smooth postoperative
recovery. The power of the left foot
became normal.
Comments
The patient still have an estimated
postoperative recurrence around 7% because the
disc space height still not shallow.
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