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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08-APRIL-2008 JALILEH RUSHDY RWESHED
70 YEARS EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
RESIDUAL AFTER DECOMPRESSIVE LAMINECTOMY L3-4-5 17 YEARS AGO FOR
The patient came to the
clinic 02-April-2008 complaining of LBP for 20
days with left sciatica for 10 days with
numbness and pain left L5 territory.
The patient was operated by
me 17 years ago for LCS L3-4, L4-5 and L5-S1.
MRI of the lumbar spine
performed 21-March-2008 showed extruded disc
L4-4 with left downward
migration with foraminal occlusion.
On examination: the patient
was limping with scoliotic stance. SLRS was 70
degrees in the right and 15 degrees in the left
with weak dorsi and planterflexion left foot
Through the previous incision
the upper bony edge of the sacrum was identified
and the scar was removed above the facets of
left L4-5 and L5-S1. To avoid massive dissection
of the scar, the image-intensifier was used to
perform neurolysis of the left L5 root and
foraminotomy of this root was achieved. The
downward migrating disc material was removed in
several pieces and the disc space of L4-5 was
cleaned from the left side.
Routine closure of the wound
with smooth postoperative recovery.
Moderate improvement of the
power of the left foot.
In the presence of scars from
previous surgery such in this case, it is
preferable to use the image-intensifier to
minimize the area of dissection.
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