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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01-FEBRUARY-2008 ASHRAF MAHMOUD ATTA 29 YEARS
EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 11-November-2007 with left sciatica and
LBP for 45 days.
The patient was limping with
scoliotic stance with MRI of the lumbar spine
performed showing extruded disc L5-S1 with left
On examination: the SLRS was
20 degrees in the left with weak dorsiflexion
left foot 3/5. Hypalgesia of the left L5 and S1 root
The patient was given
medications and if he is not improving, then
surgical treatment will be the alternative.
Exacerbation of the left
sciatica the last three days and the patient
came to the emergency of Al-Shmaisani Hospital
with almost drop left foot wand numbness of the
Left L5-S1 hemiflavotomy was
performed and left S1 foraminotomy was done. The
extruded disc material was impossible to remove
lateral to the axilla. It was pushing the nerve
The down migrating disc
material was removed from under the axilla,
after what it was possible to shift the root
medially and meticulous cleaning of the disc
space of L5-S1 was done from the left. The
epidural fat was transferred to the naked root.
Routine closure of the wound
and smooth postoperative recovery with
normalization of the power of the right foot.
Foraminotomy of the involved
root must be done in all disc surgeries to be
sure that there is no remnant left under the
The extruded disc during
surgery was more huge than in the MRI. It could
be due to improper pictures obtained during MRI,
or progression of the extrusion.
The disc height is shallow,
which decrease the expected recurrence rate.