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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21-JUNE-2010 MUNTAHA ABDELFATAH MAHMOUD 59 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
The
patient came
to the hospital with clinical history of severe
LBP and left sciatica for 5 months with pain and
numbness big toe right foot.
MRI lumbar spine
performed 2 days ago showing extruded disc L4-5
with downward migration.
On examination: the
patient has weak dorsiflexion 3/5 and
planterflexion 4/5 of the left foot. There is
hypalgesia left L5 and S1 roots.
Extended foraminotomy of the left L5 root
with left hemiflavotomy of L4-5 was achieved.
The extruded fragments were removed lateral to
the axilla and was followed down with root and
it was necessary to remove it in several pieces,
because it was adherent to the anterior wall of
the root. Further cleaning of the disc space was
done from the left side. The root was free of
any compression, but it was with deformed wall
due to old standing process.
Routine closure of the wound and smooth postoperative recovery with
improvement of the power of the left foot.
Comments
The patient had an extrusion
that was migrating down with the root,
compressing and adherent with the root.
The estimated recurrence rate
in this case is around 7%, because the disc space
is not shallow.
Due to the long presence of
the extrusion, the patient will suffer for long
time from pain and paresthesia.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
