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-JULY-2011 SAMER NAZMY SHAKER 33 YEARS
EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
patient came to the clinic 01-May-2007
complaining of right sciatica for 4 months. He
was limping with scoliotic stance. SLRS was 60
degrees in the right with pain with weak
dorsiflexion right foot 4/5. MRI lumbar spine
requested and done 02-May-2007 showing extruded
disc L5-S1 with downward migration. The patient
was advised to undergo surgery, but he
patient then came 03-July-2011 claiming that he
got deterioration the last 45 days with more
exaggerated scoliotic stance with SLRS 30
degrees in the right with pain and weak dorsi
and planterflexion right foot 4/5.
spine done 03-July-2011 showing the same
extrusion as before.
Right S1 foraminotomy with
partial flavotomy. The root is adherent to the
extrusion. The root was separated from the the
extrusion and the extrusion was removed lateral
to the axilla. Right sided cleaning of L5-S1
closure of the wound. Smooth postoperative
recovery with normalization of the power of the
right foot with disappearance of right
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The estimated postoperative recurrence rate is
around 7% because the disc space of L5-S1 still
The patient escaped the first surgery, claiming
that physiotherapy gave him relieve. In this
case the patient came after failed
The patient mostly had the disc extrusion shrunk
in size, for what he was improved, but further
extrusion took place in the last 2 months.
The adherence of root to the extrusion confirm
that the extrusion remained all the time and
further disc extrusion took place above the old
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 .