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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SUAAD ABDEL-JALEEL AL-SAADI 60 YEARS HUGE RIGHT
EXTRUDED DISC D10-11 WITH MYELOPATHIC SYNDROME.
The patient came to the
clinic 20-February-2008 complaining of LBP for
15 years with right sciatica for three years,
then left sciatica for eight months with
numbness big toe left foot.
MRI lumbar spine done
04-September-2007 showed extruded disc D10-11
right side with bulging L3-4 and L4-5. There was
weak dorsiflexion both feet 4/5.
The patient was advised to
try conservative measures and given
The patient came 05-July-2008
claiming that her condition is deteriorating
after treating her with local charlatans by
traction and applying force by wooden
On examination: the patient
in agonizing pain with scoliotic stance
with SLRS 45 degrees left side due to weakness.
She had weak dorsiflexion right foot
4/5 and weak dorsiflexion left foot 3/5 and
planterflexion left foot 4/5. There is
hypalgesia left L5 and S1 territories with weak
right quadriceps muscle 4/5.
MRI of the brain done
17-June-2008 showed small lacunar infarction
lumbar and dorsal spine were
performed 14-July-2008 showing further increase
of the extrusion of D10-11 right side and L3-4
Using image-intensifier the
D10-11 was identified.
Using Midas Rex
instrumentation, a modified right
cost-transverse approach was applied. Drilling
was done, so that the right isthmus was kept so
as not to loose stability. The disc space was
reached before violating the running ligamentum
flavum. The disc space was cleaned from the
right and the extruded disc was removed from
The ligamentum flavum was
removed to expose the dura. The bony part of the
extrusion was removed using the telescopic
attachment of Midas Rex. It was possible to
drill all the bony extrusion. By doing
this, it was possible to avoid the intended
transthoracic approach which was prepared in
Routine closure of the wound
with smooth postoperative recovery.
The patient came with
extruded disc D10-11 right side. She was not
complaining of, for what she was kept in
When the clinical course took
progressive character and the extrusion increase
and the clinical picture became evident, that
this extrusion is causing problems, it was
The use of telescoping
feature of Midas Rex, made it possible to
achieve drilling anterior to the dura, without
performing transthoracic approach.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
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 .