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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29-JUNE-2013 FUAD KHAMEES AL-ASSOOD 63 YEARS
HUGE RECURRENT EXTRUSION L4-5 LEFT SIDE.
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
Routine closure of the wound.
Smooth postoperative recovery.
The power of
left foot became normal.
The patient still has an estimated postoperative
recurrence below 7%, because the disc space is shallow
but not completely.
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