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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16-DECEMBER-2008 SUZAN MUHAMED ISSA 32 YEARS
WIDE-BASED PLD L4-5 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the
clinic 29-November-2008 complaining of LBP for 3
right sciatica and left sciatica for three
On examination: the patient
is limping with exaggerated scoliotic stance and
cannot stand up, instead with bended spine. SLRS
was 20 degrees right and 30 degrees left with
pain. She had weak dorsiflexion right foot -4/5
and left foot 4/5. Hypalgesia right L5
The patient was treated for
Ca breast 8 years ago.
MRI of the lumbar spine with
MRMyelography was performed 12-December-2008
showing wide based extrusion of L4-5 with right
Bilateral flavotomy of L4-5
was performed and foraminotomy of both L5 roots
was achieved. The extruded disc was removed from
both sides and meticulous intradiscal cleaning
of L4-5 was done. The axillae were inspected for
remaining pieces or fragments. There was no
epidural fat at the site of surgery. Routine closure of the wound.
Smooth postoperative recovery
and the power of both feet normalized.
The extruded disc was more in
the right side and the patient was complaining
more from the left sciatica, for what bilateral
cleaning was performed. The left L5 root was
more compressed and even adherent at the inner
angle of the left axilla to the surrounding
tissues. This explain why she was suffering from
The expected recurrence rate
in this case is above the average, because the
disc space height still nor shallow and so as to
perform meticulous cleaning , it was necessary
to removed the disc material from 2 points in
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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 .