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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18-JUNE-2009 FADY FAKHRY QOZAH 33 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 17-June-2009 complaining of LBP for 2
years with left sciatica the last 4 months with
exacerbation of sciatica the last month with
numbness left foot.
MRI lumbar spine performed
15-June-2009 showing extruded disc L4-5 with
left downward migration and sacralization of L5.
On examination: the patient
was limping with weak dorsiflexion left foot 4/5
and exaggerated scoliotic stance. SLRS was 30
degrees with pain in the left.
Using image-intensifier, the
L4-5 level was identified with the use of
methyline blue. Left L5 foraminotomy
was performed after performing left L4-5 partial
flavotomy. The extruded disc was removed lateral
to the axilla and meticulous cleaning of L4-5
disc space was achieved from the left. Routine
closure of the wound
Smooth postoperative recovery
with improvement of the power of the left foot.
The patient still having
considerable height of the disc space, which
make the expectation of recurrence higher than
So as to avoid dramatic
clinical deterioration in case of possible
recurrence the foraminotomy was extended more
down to have ample to the root in case of
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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 .