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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14-JUNE-2009 ABDALLAH MUHAMED HASAN AL-HORANY 58
YEARS PLD L3-4 WITH LEFT FORAMINAL COMPRESSION AND RIGHT DOWNWARD
The patient was operated by
me 18-November-2008 for lumbar canal stenosis
L3-4 and L4-5. The patient did well, but he came
back 05-May-2009 to the clinic complaining of
LBP and left sciatica for 2 months. The patient
is a known diabetic with 90 units of humilin
daily with glucophage 850 mg twice daily.
On examination: the patient
was limping with weak dorsiflexion left foot 4/5
and hypalgesia right L5 territory.
MRI lumbar spine, which was
done 04-June-2009 showed extruded disc L3-4 with
left foraminal occlusion and right downward
Using image-intensifier, the
L3-4 level was identified. Neurolysis of left L4
root was performed. The extruded disc was
adherent to the root and there was a small tear
in the root. The extruded disc was removed from
the left side and meticulous cleaning of the
disc space was performed from the left. The
dural defect was covered with 2 layers of muscle
and water-tight cleaning of the wound was
Smooth postoperative recovery
with improvement of the power of the left foot.
The patient was operated
first for lumbar canal stenosis 7 months ago.
During that time there was no extrusion of L3-4.
The tear in the dura was seen
despite the fact that all precautions were
undertaken to avoid that. The cause of the tear
mostly is due to the friction with the small
pituitaries during disc removal.
Closure of the defect was
impossible, because there were only scars. The
only solution was tamponading the defect with 2
layers of muscle filling the defects and sealing
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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 .