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

The patient complaining of agonizing pain in the left lower limb for several months with drop left foot. MRI demonstrated an old extrusion full-filling the entire track of the left L5 root. The patient was operated. Left hemiflavotomy L4-5 with foraminotomy of left L5 root was performed, using drilling to avoid surgical trauma to the root. The extruded part was removed and the root was inspected. The dorsal ganglion was absent due to compression and 8 mm below the axilla the root was deficient of its dural sleeve and the roots were seen running, but severely damaged. It was decided not to violate them, since no CSF leak was coming and the cul de sac was very tense due to bad positioning of the patient. The abdomen was not hanging free. Intentionally, the patient was kept in this position to allow if CSF leak take place, so as to resolve the problem, but this was not the case. Closure.

The patient after the operation got improvement of the foot power and she was discharged the next postoperative day.

Comment: It is the first time, to me at least, to see such morphological damage to the root, that gave the feeling, that no improvement could take place. It is hard to predict, and this patient showed dramatic recovery.