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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04-AUGUST-2008 MUHAMED ADNAN SHEHADEH 69 YEARS
HUGE EXTRUDED DISC L3-4 WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 12-January-1999 complaining of
LBP with without sciatica for 5 years. MRI of
the lumbar spine done 20-November-1998 showed
extruded disc L3-4. He had prostate hypertrophy
in cardura for 2 years.
On examination at that time:
he had exaggerated scoliotic stance with weak
dorsiflexion left foot 4/5. The patient was
The patient then came
02-December-2003 with exacerbation of LBP
without sciatica. His clinical status was the
same as before and the MRI performed
13-November-2003 was the same as before. The
patient was treated conservatively.
The patient then came
16-July-2008 complaining of severe left sciatica
for the last three days.
On examination: the patient
in agonizing pain with exaggerated scoliotic
stance with SLRS 75
degrees in the left with pain with weak dorsiflexion right foot
MRI of the lumbar spine was
performed 15-July-2008 showing huge PLD L3-4
with left downward migration.
Using image-intensifier, the
L3-4 level was identified and left L3-4
hemiflavotomy and left L4 foraminotomy was done.
The epidural fat was missing at the compressed
parts and the root was severely compressed. The
downward migrating piece was removed lateral to
the axilla in two separate pieces, after what
the root became lax. Meticulous cleaning of the
disc apace was performed from the left side.
Routine closure of the wound
with normalization of the power of the left
The patient came several
times over 10 years. He was treated
conservatively. But the last time when the
extrusion became huge with downward migration,
surgery was the only solution.
Meticulous cleaning of the
disc space could lower the estimated incidence
of recurrence rate.
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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 .