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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07-FEBRUARY-2009 MUHAMED KAMEL SALAMAH 58 YEARS
OLD NEGLECTED EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION AND LUMBAR CANAL
The patient is a doctor, came to the
clinic one year ago with a history of
LBP and agonizing left sciatica. He was advised
to undergo surgery at that time, but he escaped.
The patient then came
04-February-2009 complaining of left sciatica
and numbness of the left foot. Exacerbation of
the pain the last 2 weeks.
MRI lumbar spine performed
21-January-2009 showed huge extruded disc L5-S1
with left downward migration and lumbar canal
On examination: the patient
is limping with scoliotic stance. SLRS was
limited to 80 degrees in the left with absent AJ
dorsi - -4/5, and planterflexion left foot -
Decompressive laminectomy of
L5 and partial of L4 with foraminotomy of left
S1 root was performed. The dura was absent at
L4-5 level with very transparent dural sheath.
The extruded disc was removed subaxillary and
part of it was adherent to the running root,
which was dissected off respectively. The
intradiscal space was shallow and the disc space
was empty, for what no material was harvested
from there. Inspection of the transparent dura
at L4-5 level showed a tiny microscopic
pin-point CSF leak, which was coagulated first,
but the CSF continued to flow, for what 6 zero
nylon was used to close the tear in one stitch.
Check for CSF leak was negative. Routine closure of the wound.
The patient has small defect
of the annulus fibrosis, and the disc space
height is shallow and the intradiscal space is
empty, for what the estimated
recurrence rate is ranking very low.
The dura was very thin, that
spontaneous CSF leak took place from the
thinnest point. It was managed accordingly.
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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 .