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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15-FEBRUARY-2010 UMAR MUHAMED ALIAN 54 YEARS
EXTRUDED BLACK COLORED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
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The patient came to the
clinic 14-February-2010 complaining of LBP for 2
months with right sciatica and numbness right S1
territory and positive cough sign and unable to
On examination: the patient
is in wheelchair and in agonizing pain. SLRS was
in the right side. The right AJ
is absent in the right side with drop right foot
and weak planterflexion 3/5. There is hypalgesia
right S1 territory.
MRI lumbar spine
done 13-February-2010 showing very huge
extrusion L5-S1 with right far downward
migration. The other disci are dehydrated with
Right L5-S1 hemiflavotomy
with foraminotomy right S1 root down up to 10 mm
to expose the subaxillary region. The extruded
disc was removed in several pieces. It was black
in color with black reactionary changes of the
epidural tissues around the extrusion. Right
sided cleaning of the disc space of L5-S1. The
disc material and the annulus fibrosis were all
also black with violet color attenuation.
Satellite spinal system, was not necessary
the disc space was very shallow. The osteophytic
bony extrusion was drilled out to eliminate all
the compressive elements near the root.
The disc material
and the extrusion was sent for biopsy.
Routine closure of the wound.
recovery, with normalization of the power of the right foot
disappearance of right sciatica.
The surgeon thinks
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
In retrospective analysis with the family, it
became clear that half of the family showing
ochronosis, for what the disc material was
black blue in color. This is the second case in
my experience over 30 years having such a case.
shallow space of L5-S1 make it meaningless to
use the PEEK Satellite sphere.
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 .