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-SEPTEMBER-2008 DR. AWNI MUHAMED AL-BASHIR 52
YEARS EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
The patient started to
complain of agonizing right sciatica for one day
prior to admission 04-September-2008. MRI
performed 03-September-2008 showed an extruded
disc L5-S1 with right downward migration.
On examination: he has
hyperlipedimea and hypertension with high K
level with some parameters, which required
correction before surgery. He had weak
dorsiflexion right foot 4/5 and hypalgesia right
Right S1 root foraminotomy
was performed and partial flavotomy was
achieved. The epidural fat was rubbery at the
disc level and using image-intensifier the
shallow disc space of L5-S1 was identified.
It was impossible to remove
the extruded disc lateral to the axilla and the
extrusion was severely compressing the nerve. It
was necessary to go down and extend the
foraminotomy and to attack the far migrating
disc material under the axilla. It came in
several pieces, after what the root became
Inspection of the disc space,
revealed that the disc space is very shallow and
there is tiny defect under the annulus fibrosis.
Taking these data in mind, it was decided not to
violate the disc space of L5-S1 to minimize the
estimated postoperative recurrence.
Routine closure of the wound
and smooth postoperative recovery.
The patient had very shallow
disc space of L5-S1 with tiny defect of the
annulus fibrosis. Leaving the disc space
untouched, will yield better postoperative
outcome with less expected postoperative
The estimated recurrence rate
in this case is around zero.
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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 .