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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11-SEPTEMBER-2008 NAZEK BADEE ISSA 45 YEARS
HUGE EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.
The patient came
10-September-2008 with agonizing left sciatica
for 20 days and inability to walk or stand the
last 2 weeks. She had LBP with minimal left
sciatica for three years.
MRI performed 30-August-2008
showing extruded disc L4-5 with left foraminal
On examination: the patient
was dancing due to pain and she could not be
evaluated for scoliotic stance and SLRS.
She had weak dorsi 3/4 and planterflexion 4/5 of
the left foot with OA left knee and she had
psoriasis and hypertension for 4 years.
Left L5 root foraminotomy
was performed and partial flavotomy was
achieved. There was no epidural fat at the disc
level and a huge calcified ganglion arising from
the left L4-5 facet was removed and drilled off.
The extruded disc was also
compressing the nerve from anterior, for what
left sided cleaning of the disc space was
performed, after what the root became lax.
Routine closure of the wound
and smooth postoperative recovery.
The patient had very
disc space of L4-5 , for what the estimated
recurrence rate is below 7%.
The major role in compression
in this case was the extruded ganglion from the
left facet joint, which mimicked a huge
extrusion with foraminal occlusion.
MRI was not informative to
catch this situation before surgery. More
precise resolution and new modifications of MRI
or other technologies must give the answer for
this situation before surgery. We hope in the
near future, this problem to be resolved.
Please! wait for 3-5 min till the
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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 .