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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  neurosurgery.tv

 
01-AUGUST-2006 SAHAR MAHMOUD FREHAT  44 YEARS  HUGE LEFT L4-5 DISC EXTRUSION WITH UP AND DOWNWARD MIGRATION
The patient came to the clinic 30-July-2006  with LBP and left sciatica for 2 months  with exacerbation of the sciatica the last week with positive cough sign. MRI of the lumbar spine performed 30-July-2006 showed huge extrusion of L4-5 disc with left up and downward migration with bulging L5-S1 disc.

On examination: the patient had exaggerated scoliotic stance with SLRS 50 degrees shooting to the left side and 5 degrees in the left side. She had hypalgesia of the left L5 and S1 territories with almost drop left foot and weak dorsiflexion right foot and planterflexion left foot.

Left L4-5 hemiflavotomy with foraminotomy of the left L5 root was performed and the extruded disc was removed in one piece lateral to the axilla. The defect in the annulus fibrosis was medium and the disc material during cleaning of disc space was relatively healthy, for what minimal cleaning was attempted.

Prompt postoperative recovery.

Comments:

1. The consistency of the intradiscal material play a role in the limits of cleaning. In case that the defect in the annulus fibrosis in minimal or medium, it is preferable to limit intradiscal cleaning to the intradiscal sequestrated material. If the material looking healthy, then it is better not to violate it.

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