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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10-FEBRUARY-2010 NABEEL MUHAMED ABU-SHAARA 37
YEARS HUGE EXTRUDED DISC L5-S1 BOTH SIDES.
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The patient came to the
clinic 14-April-2009 complaining of neck and LBP
for 6 years. He was limping with no
scoliotic stance with SLRS 30 degrees both
sides. There was weak dorsiflexion both feet
13-May-2009 showing extruded disc L5-S1 central
more to the right. The patient was advised to
try conservative treatment and
The patient then came
07-February-2010 complaining of bilateral
sciatica more to the left for 2 weeks with
numbness left foot. The patient was limping with
exaggerated scoliotic stance with SLRS 20
degrees in the right and 5 degrees in the left
side. He had drop left foot with left foot
planterflexion 2/5 and dorsiflexion right foot
-4/5 and planterflexion right foot 4/5. He had
hypalgesia left L5 and S1 territories.
MRI lumbar spine requested and
done showing the old extrusion of L5-S1 and
fresh extrusion in the left side.
Bilateral flavotomy of L5-S1 and
bilateral foraminotomy of S1 roots was achieved.
The extruded disc was removed from both sides
and meticulous cleaning of the disc space was
achieved from both sides.
Satellite spinal system, was not necessary
because the disc space was shallow.
Routine closure of the wound.
recovery, with improvement of the power of both
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 even both sides, using the
The shallow disc
space means minimal disc recurrence, for what
the idea of nucleus replacement device was
abandoned in this case.
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 .