Munir Elias 20-12-2013

Dr. Ali Al-Bayyati and Dr. Munir Elias

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

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12-NOVEMBER-2012  YUSRA JUMAA NOFEL  47 YEARS  EXTRUDED DISC L5-S1 WITH LEFT UPWARD MIGRATION.

 

Anamnesis

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The patient came to the clinic 09-Aprel-2005 complaining of LBP and left sciatica for 13 years with neck and right upper limb pain for one year. She underwent left CT release 18 months ago without improvement. MRI lumbar spine done 06-February-2002 showed extruded disc L5-S1 with left downward migration. On examination at that time, she had weak grip right hand and right triceps muscle with neck pain when looking to the right. SLRS was 50 degrees in the left with pain with weak planter and dorsiflexion left foot 4/5. MRI of the neck and lumbar spine performed 26-May-2007 showed small extruded disci C5-6, C6-7 and PLD L4-5 and L5-S1. It was decided to continue conservative treatment.

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The patient then came 07-November-2012 with LBP and left sciatica for 4 months and exacerbation the last week with agonizing pain and numbness of the left foot.

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On examination: the patient is limping with exaggerated scoliotic stance. SLRS 20 degrees in the left with pain and 50 degrees with pain shooting to the left leg. There is weak dorsiflexion both feet 3/5.

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MRI lumbar done 10-November-2011 showing huge extruded disc L5-S1 with far left upward migration. The patient since insured was hospitalized at Tachasusi hospital and the radiologic report is missing and she was treated for neuritis. The patient was transferred to Shmaisani hospital.

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Partial left L5 hemilaminectomy with foraminotomy left S1 root. The extruded disc L5-S1 was removed lateral to the axilla. Osteophytectomy was done to eliminate all sources of compression with meticulous cleaning of L5-S1 disc space from the left. Inspection of the left L5 root territory to rule out remnants of any fragments.

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Routine closure of the wounds. Smooth postoperative recovery. The power of the left foot became normal.

 

 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient had several extrusions of the L5-S1 with changing character. The last attack was the last straw, which brought the patient to the operating table.

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Since the extrusion had old and new components, it is natural to remove the fresh and osteophytic components of the extrusion.

 

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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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