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28-FEBRUARY-2007 MUHAMED AHMAD BASALEEM 35 YEARS SECOND RECURRENCE OF L5-S1
DISC RIGHT SIDED.
Anamnesis
The patient was transferred from the airport
arriving from YAR directly to Shmaisani hospital
with agonizing right sciatica. The patient was
operated for recurrence of huge disc L5-S1
27-October-2006 by me. The condition started
7 days ago, during lifting heavy object with
rotational element.
MRI performed 4 days ago showing small extrusion
of L5-S1 compressing the right S1 root causing
the agonizing sciatica, but with no neurological
deficit.
Considering that, he came from far with
agonizing sciatica, it was decided to reoperate
him. If he was a Jordanian citizen, then it was
better to wait for 1-2 months to see if his
extrusion shrinking, but due to socio-economic
reasons, he was sent to the operating room.
The old incision was refreshed and the right
upper corner of the lamina was widened for 2 mm
and the scar was removed, so as to expose the
right S1 root. During this, the extrusion came
out, before reaching the disc space. It was
removed. The right S1 root was explored further
down and inspection for more remnants revealed
another small fresh pieces, which were removed.
The disc space was so narrow, that only a tiny
microswedish was able to be introduced to the
disc space. A small sized pituitaries were
unable to introduced to the disc space. The
right S1 root hanging free. Routine closure of
the wound.
Immediate disappearance of the right sciatica
after surgery.
Comments
In the previous second operation, the
expectation for recurrence was minimal. But it happened 5
months later.
During the second surgery the annulus was
acceptable and the intradiscal space was not violated.
If the disc space permit further cleaning of the intradiscal
material, it is better retrospectively to perform cleaning,
because even if the disc space is narrow, there could be
pieces or fragments ready to slip later.
It is still a dilemma , what exactly better for the patient
to perform. Remove the extrusion without violating the disc
space, or perform meticulous cleaning of the intradiscal
space.
There are cases with 5-8 time of recurrence and this
phenomenon needs solution.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
fixation is the most accurate system in the market. The microdrive and
its sensor gives feed back about the localization.
Inomed MER system
Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
LooksCam II in the run starting from 14-March-2020
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 .
