Munir Elias 20-12-2013

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11-JANUARY-2014  NADIA MAHMOUD KHAMEES  37 YEARS  HUGE OLD EXTRUSION OF L5-S1 WITH RIGHT DOWNWARD MIGRATION.

 

Anamnesis

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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.

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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.

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The patient then came 29-December-2013 with the same LBP and sciatica. She performed sleeve for obesity in February-2012.

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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.

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MRI lumbar spine done 29-December-2013 showing the same extrusion of L5-S1 as before.

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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.

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Smooth postoperative recovery. The power of the right foot became better.

 

 

Comments  

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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.

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Key hole surgery is a welcome one, but wrong approach to the wrong level with doing nothing is not acceptable.

Leica HM500

Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.


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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