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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13-SEPTEMBER-2008 ALI MUHAMED ALI
AL-HAJJY 38 YEARS DE NOVO RECURRENT PLD L4-5
The patient came
to the clinic 06-September-2008 complaining of
LBP for 1 year with exacerbation of right
sciatica the last 13 days.
The patient was operated by
for extruded disc L5-S1 and L4-5 left side.
MRI performed 04-September-2008
showing extruded disc L4-5 with right foraminal
On examination: the patient
was limping with exaggerated scoliotic stance
with weak dorsiflexion right foot 4/5 and
hypalgesia right L5 territory.
Considering that the extruded
disc was soft a trail for conservative treatment
was suggested to the patient, but the patient
came 12-September-2008 complaining of agonizing
Drilling of the upper right
corner of the previous partial laminectomy of L4
was achieved and the ligamentum flavum was
detached from the running right L5 root. The
extruded disc was removed lateral to the axilla.
Right sided cleaning of the practically empty
disc space of L4-5. Some part of the extrusion
was adherent to the root, removal of what caused
a 1 mm tiny tear of the dural sleeve of the
root. It was coagulated by bipolar to shrink the
tear and small piece of muscle was applied over
that area. Valsalva maneuver revealed no CSF
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%.
It was more wise to leave the
L4-5 disc in the first surgery untouched,
because, even the extrusion was in the
contralateral side, but it was triggered by the
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .