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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05-OCTOBER-2012 QASEM HUSSEIN ALI 48 YEARS
HUGE EXTRUDED DISC L5-S1 WITH LEFT UP AND DOWNWARD MIGRATION.
The patient came to the Shmaisani hospital 04-October-2012
complaining of LBP for 15 years with
intermittent course and agonizing left sciatica
for 2 weeks down to the left S1 territory with
numbness of the III-V toes left foot with
inability to walk the last week. The patient is
a known diabetic for 5 years and with arterial
hypertension for 2 years.
MRI of the lumbar spine done 29-September-2012
showing huge extruded disc L5-S1 with left up
and downward migration.
On examination, the patient is unable to stand
with agonizing pain. SLRS was 65 degrees with
pain in the left. There is weak dorsi and
planterflexion left foot -4/5. with hypalgesia
left L5 and S1 territories. The left AJ is
Left L5-S1 hemiflavotomy with
foraminotomy left S1 root. The root was severely
compressed posterior by the extrusion. The
extrusion was removed in steps to avoid injury
to the compressed root and it was removed in one
big piece. Trying to avoid widening of the
defect in the annulus fibrosis, intradiscal
cleaning of L5-S1 was achieved. The running
epidural veins were preserved. Inspection for
remnants subaxillary was negative. The root
hanging free, but lacking the epidural fat. We
Guardix-sol because it seems that it cause
some sort of chemical neuritis and the followed
postoperative MRI showed massive fibrosis due to
reaction with Guardix-sol.
Routine closure of the wound. Smooth
postoperative recovery and the power of the left
foot became normal.
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The patient still has an
estimated postoperative recurrence around 10%,
because the disc space is still high.
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