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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21-MAY-2012 MAHBUBA HASAN AL-BALAAWI 55 YEARS
HUGE EXTRUDED DISC L4-5 MORE TO THE LEFT WITH SEVERE SEGMENTAL STENOSIS.
patient came to the clinic 13-May-2012
complaining of LBP for 15 years with left sciatica
for 10 years. She notices deterioration the last
7 months with bilateral sciatica more to the
left. MRI lumbar spine performed 03-May-2012
showing huge extruded disc L4-5 more to the left
with severe segmental stenosis.
examination, the patient cannot walk more than
50 meters due to pain. She is limping with
exaggerated scoliotic stance. SLRS was 80
degrees with pain in the right and 85 degrees in
the left with pain. Weak dorsiflexion left foot
3/5 and dorsiflexion right foot and
planterflexion both feet -4/5.
Bilateral foraminotomy L5
roots. The dura was transparent due to severe
compression. Removal of the extrusion lateral to
the left L5 axilla with cleaning of the L4-5
disc space. The left L5 root still tightly
elevated backward, for what subaxillary
inspection was performed. An extradural
fragments were removed, followed with intradural
pieces were pulled out from the dural defect
under the axilla. The intradural pieces were not
violating the subarachnoid, for what CSF leak
was not noted. Putting the patient in head up
position with Valsalva maneuver did not trigger
CSF leak. A piece of muscle was put at the dural
defect for 2 reasons, to stop the epidural
bleeding and prevent postoperative CSF leak.
closure of the wound. Smooth postoperative
recovery and the power of both feet normalized.
Please! wait for 3-5 min till the
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The patient has lumbar
canal stenosis of L4-5 with huge extruded
disc more to the left. Bilateral cleaning is a
The estimated postoperative recurrence is around
7%, because the disc space height is still not
It is rare to see an intradural sequester of the
extruded disc. It happens in 0,5% cases. Missing
these fragments will make the patient suffer and
it happened in some patients, that they
underwent 10 redo surgeries for missing these
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 .