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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19-JANUARY-2008 MAHER MAHMOUD MAHMOUD 50 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION AND INTRADURAL INVOLVEMENT.
The patient came to the
clinic 06-January-2008 complaining of neck and
left upper limb pain for 45 days. MRI of the
cervical spine performed 01-January-2008 showing
extruded disc C6-7 left side and bulge C5-6.
The patient walking with
crutches after falling down 2 months ago. The
patient was operated 13 years ago for PLD L5-S1
after what he complained of left sciatica and
almost drop left foot with anaesthesia of the
left L5 territory. For the cervical pathology,
the patient was advised to try conservative
The patient came
09-January-2008 with MRI lumbar spine performed
14-September-2007 showing recurrence of PLD.
The patient was sent for
another MRI, which was performed 11-January-2008
showing assimilation of L5 with S1 with
recurrent disc L4-5 with left downward migration
and possible intradural involvement.
Using image-intensifier, the
level was identified and left L4-5 hemiflavotomy
with left L5 foraminotomy was performed. The
extruded disc was attacked lateral to the
axilla. Piecemeal resection of the extrusion was
done using micropituitaries from the
percutaneous kit. After removing the
intradurally extruded disc fragments CSF came
out. The dural defect was closed with 2 nylon 6
zero stitches and covered with thread of muscle.
The disc space was very
shallow and cleaning from the left side was
Routine closure of the wound.
Smooth postoperative recovery
and the power of the left foot dorsiflexion
The patient has shallow disc
space. This indicate low expectation for
Studying the MRI carefully,
the intradural compartment was discussed with
the patient preoperatively and it was corrected
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