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-FEBRUARY-2010 TAYSEER SABRY AL-EWENAT 56 YEARS
HUGE EXTRUDED DISC L4-5 WITH FAR MIGRATING DISC TO THE LEFT L5 ROOT.
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The patient came to the
clinic 06-February-2010 complaining of LBP since
1995. 3 weeks ago got severe LBP with agonizing
left sciatica. Three days ago the pain suddenly
disappeared but drop left foot took place with
numbness of the left L5 territory.
28-January-2010 showing extruded disc L4-5 with
far downward migration to the foramen of the
left L5 root.
On examination: the patient is
limping with mild scoliotic stance. He had drop
left foot with diabetic neuropathy above the
ankles both feet. The patient is a known
diabetic with hypertension and hyperlipidemia.
He performed cath 3 times with normal results.
image-intensifier the L4-5 level was identified
and left hemiflavotomy L4-5 with foraminotomy
of the left L5 root was performed. The extruded
disc was removed from under the axilla and left
sided cleaning of L4-5 was done from the left.
Satellite spinal system, was not necessary
because the disc space was shallow.
Routine closure of the wound.
recovery, with improvement of the power of left
The surgeon think
that he performed meticulous cleaning of the
disc space, but it is not true. It is impossible
to clean the disc space from one side using the
The shallow disc
space means minimal disc recurrence, for what
the idea of nucleus replacement device was
abandoned in this case.
The explanation of sudden
disappearance of sciatica, that the extruded
disc slipped down to the canal for more than 8
mm below the disc space level.
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 .