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-JUNE-2008 SAMIR ATIYEH KHALEEL 48 YEARS
HUGE RECURRENT EXTRUDED DISC L5-S1 MORE TO THE LEFT.
The patient came to the
hospital 08-June-2008 with agonizing bilateral
sciatica for three months more the left. He was
operated 2006 for PLD L5-S1 for the same
MRI lumbar spine performed
29-May-2008 showing very huge recurrence at
L5-S1 more to the left.
On examination: the patient
has weak dorsiflexion both feet 4/5 right and
-4/5 left, and planterflexion left foot 4/5, with hypalgesia of the left lower
limb above the knee joint.
The patient is known
diabetic, under treatment with Mixtard 25 and 35
Interestingly, the old scar
was perpendicular to the midline. A midline
incision was performed, ignoring the old one.
Left L5-S1 hemiflavotomy with
foraminotomy of left S1 root was performed. The
extruded disc was removed lateral to the axilla.
The scar was removed along the root and superior
to the axilla, since the major part of the
extrusion was upward. It was necessary to
approach the upward migrating part through
isolated route. Meticulous cleaning of the disc
space from the left side.
Smooth postoperative recovery
and normalization of the power of both feet.
The recurrence rate in
this case is lower than the average, because the
disc space height is minimal.
Recurrent disc leave scar,
for what dissection must be started from the
Good imagination of the
extrusion must be kept in mind so as not to miss
the extrusion, as in this case. It was necessary
to perform isolated surgical route to remove the
upward migrating big piece.
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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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