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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ABDEL-RAZAQ SALEM AL-KHATEEB 60 YEARS EXTRUDED
DISC L2-3 WITH RIGHT UPWARD MIGRATION AND FORAMINAL OCCLUSION.
The patient came to the
clinic 22-October-2008 complaining of LBP for 4
years with intermittent course. The last
week got exacerbation of right sciatica not
reaching below the right knee.
The patient is under
treatment for diabetes mellitus and arterial
On examination: the patient
is limping with exaggerated scoliotic stance,
with SLRS 80 degrees in right side with pain and
weak dorsi and planterflexion right foot 4/5.
MRI lumbar spine was
performed 22-October-2008 showing extruded disc
L2-3 with right upward migration occluding the
Using image-intensifier, the
L2-3 level was identified and 0.2 ml methylen
blue was used to to keep the landmark. Right
L2-3 hemiflavotomy was performed and drilling of
the lower part of the L2 lamina was performed
from the right to catch the upward migrating
piece, which was removed in several fragments.
Inspection of the annulus fibrosis showed that
the disc material still ready to extrude, for
what meticulous cleaning of the disc space was
performed from the right.
Smooth recovery with prompt
improvement of the power of the right foot.
The patient has severe
compression of the right L2 root with the upward
migrating fragment, occluding the foramen. The
neurologic deficit is not compatible with the
lesion. Anyhow, neurological examination is by
no means all the time can confirm the
The expected recurrence rate
in this case is around the average, because the
disc space height is not shallow and the annulus
fibrosis defect is not large enough.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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