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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09-FEBRUARY-2009 SAADIYEH HASAN AWWAD 48 YEARS
HUGE CENTRAL EXTRUDED DISC L4-5.
The patient came to the
clinic 11-October-2006 complaining of left
sciatica for 10 days with scoliotic stance and
weak dorsiflexion left foot 4/5. Investigations
were requested, but she disappeared.
The patient then came
27-August-2008 complaining of LBP and left
sciatica and MRI lumbar spine performed
22-September-2008 showing extruded disc L4-5
more to left. She was advised to undergo
conservative treatment and in case of not
improving, then to consider surgery.
The patient then came
02-February-2009 with deterioration of her left
sciatica and inability to raise her right leg
with weak dorsiflexion both feet 4/5.
MRI lumbar spine performed
08-February-2009 showed very huge extruded disc L4-5
with central localization, resulting in
secondary lumbar canal
On examination: the patient
is limping with scoliotic stance. SLRS was
limited to 0 degrees in the right and 90 degrees
in the left with absent AJ
Bilateral foraminotomy of L5
roots and bilateral cleaning of the extrusion.
It was performed lateral to the axilla from the
left and subaxillary from the right. Meticulous
cleaning of the disc space of L4-5 was achieved. 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.
recovery with normalization of the power both
The patient has wide defect
of the annulus fibrosis and the disc space is
not shallow, for what the estimated recurrence
rate is around 7%.
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
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