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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11-JANUARY-2014 NADIA MAHMOUD KHAMEES 37 YEARS HUGE
OLD EXTRUSION OF L5-S1 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the clinic 04-August-2011
complaining of LBP with right sciatica and
numbness of the right foot for several months.
The patient was operated in Italy for PLD L5-S1
in April-2010. MRI lumbar done 03-February-2010
before surgery showing huge extruded disc L5-S1
with right downward migration. MRI repeated
21-June-2010 after surgery showing the same
extrusion as recurrence.
On examination at that time: the patient was
limping with exaggerated scoliotic stance. SLRS
was 30 degrees with pain in the right. Babinski
was questionable in the right side with right
sided hemiparesis and hemihypalgesia. The
patient came then 03-October-2011 with MRI of
the lumbar spine done 25-September-2011 showing
the huge recurrence at L5-S1. She was advised to
undergo surgery, but she refused. MRI of the
brain done 14-February-2012 and it was normal.
The patient then came 29-December-2013 with the
same LBP and sciatica. She performed sleeve for
obesity in February-2012.
On examination: the patient still limping with
exaggerated scoliotic stance with SLRS 30
degrees with pain right side. There is profound
weak dorsi and planterflexion right foot 2/5.
Hypalgesia above the right knee down to the
entire right foot.
MRI lumbar spine done 29-December-2013 showing
the same extrusion of L5-S1 as before.
The old small oblique
incision refreshed and the scar area followed.
Check level with C-arm, it was the L4-5 level.
Inferior dissection was carried out from the
same incision to perform foraminotomy of the
right S1 root. The extruded disc was removed
from under the axilla. Right side cleaning L5-S1
disc space. Another check level even after
completion of the surgery. Routine closure.
recovery. The power of the right foot
The patient has neglected huge extrusion of
L5-S1. Recovery of motor function will be
acceptable, but the pain with dyseasthesia will
have a long protracted course over the years.
Key hole surgery is a welcome one, but wrong
approach to the wrong level with doing nothing
is not acceptable.
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