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Dr. Fuad Al-Masri Syrian neurosurgeon.

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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29-JUNE-2013  FUAD KHAMEES AL-ASSOOD  63 YEARS  HUGE RECURRENT EXTRUSION L4-5 LEFT SIDE.

 

Anamnesis

The patient came to the clinic 09-December-2012 complaining of LBP for 2 months with left sciatica for 1 week. The patient was operated 2002 for extruded disc L4-5 and 2006 for extruded disc L5-S1 elsewhere. Cath and stinting was applied 7 years ago.

On examination: The patient was limping with exaggerated scoliotic stance. SLRS was 85 degrees with pain in the left. Weak dorsiflexion right foot -4/5. There was hypalgesia left L5 root.

MRI lumbar spine done 27-December-2012 showed huge recurrent extruded disc L4-5 with left foraminal occlusion. The patient was advised to undergo surgery, but he escaped.

The patient then came 27-June-2013 telling that he dramatically deteriorated the last month with agonizing left sciatica. MRI of the lumbar spine done 26-June-2013 showing the huge extrusion of L4-5 still occluding the left foramen. SLRS was 70 degrees in the left with pain and weak dorsiflexion left foot -4/5 and planterflexion 4/5 with hypalgesia left L5 and S1 territories.

Exposure of the left L5 root and scarolysis. There was a pin point dural defect which was closed by 6 zero nylon. The huge extruded disc L4-5 was removed lateral to the axilla, after which the root became lax. Left sided intradiscal cleaning of L4-5 disc space.

Routine closure of the wound. Smooth postoperative recovery. The power of left foot became normal.

 

 

Comments

The patient still has an estimated postoperative recurrence below 7%, because the disc space is  shallow but not completely.

Leica HM500

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Back Up!

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

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