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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03-MARCH-2008 SAEED MUHAMED SAEED AL-BLUSHY 73
YEARS REDO AFTER FAILED RIGHT FORAMINAL DECOMPRESSION OF L3-4 DISC.
The patient came to the
clinic 01-March-2008 complaining of LBP and
right sciatica down to the right knee for 7
months. He is using crutches for 13 years after
performing bilateral total knee replacement in
lumbar spine done 20-September-2007 showing
extruded disc L3-4 with right foraminal
occlusion, totally obliterating and compressing
the running root.
The patient performed locally
in Bahrain right hemiflavotomy of L3-4 10 days
after the MRI, without any benefit.
MRI lumbar spine done
04-February-2008 showing the same compression at
the mentioned level.
On examination: the patient
is limping and dragging his right leg and has scoliotic stance. SLRS was
degrees in the right and 80 degrees in the left
with radiating pain to the right side of the
loan and the right hip and down to the left
patient had weak dorsiflexion and planterflexion
4/5 and hypalgesia right L3 territory.
The patient was sent for
CT-scan of the pelvis with pelvis X-ray to rule
out other associated lesions. The performed
investigations ruled out the presence of other
causes of his problem.
Laminectomy of L3 was done
and using the image-intensifier the anatomical
landmarks were identified. Foraminotomy of right
L4 root was performed. The extruded disc was
removed from the far-lateral position of the
disc space of L3-4 and after intradiscal and
extradiscal cleaning, the root was seen pushed
up. All the compressive bony and soft tissues
elements were removed, after what the root
regained relax position. It was inspected until
its emergence from the right foramen.
Routine closure of the wound
and smooth postoperative recovery with
normalization of the power of the right foot.
So as to perform adequate
foraminotomy without causing instability, it is
necessary to use high-speed drilling, to prevent
the bony structures and eliminate all the
compressive elements around the compressed root.
According to the previous
scar, the pathological process was more superior
and it was necessary to go up 10 mm to find the
emerging root and release it from proximal to
distal. It was pushed up and far-lateral.
The expected recurrence rate
here is below average, since the disc space is