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-NOVEMBER-2008 BAKER MAHMOUD AL-MADY 42 YEARS
HUGE EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the
clinic 21-October-2003 complaining of LBP for 2
years with intermittent course. Right
sciatica for 1 year.
MRI lumbar spine performed
19-October-2003 showed wide-based extrusion of
L5-S1 more to the right.
On examination at that time:
SLRS was 50 degrees in the right with pain
with weak dorsiflexion right foot 4/5. The
patient was advised to undergo conservative
The patient then came
20-October-2008 with exacerbation of LBP and
right sciatica the last 7 months. MRI performed
04-March-2008 showed small extrusion of L5-S1
right side. one week ago after coughing the
patient got an agonizing sciatica and start to
On examination: the patient
is limping with exaggerated scoliotic stance,
with SLRS 15 degrees in right side with pain and
weak dorsi and planterflexion right foot -4/5.
MRI lumbar spine was
performed 21-October-2008 showing huge extruded disc
L5-S1 with right downward migration.
Partial flavotomy L5-S1 right
side with foraminotomy right S1 root was
performed. The new downward migrating disc
material was removed lateral to the axilla. The
old disc martial also was compressing the root,
for what removal of the calcified annulus
fibrosis with the hard disc material was removed
to achieve proper decompression. Meticulous
cleaning of the disc space was done from the
Smooth recovery with prompt
improvement of the power of the right foot.
The patient had several
surges of pain and surgery was decided only when
the extrusion got huge amount. If the patient
was operated upon during the early period , he
will not feel the benefits of surgery, in the
contrary he could have worse post-surgical
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 relatively large after
removing the calcified annulus fibrosis and the
old hard extrusion.
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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 .