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-NOVEMBER-2008 ADOUL MUHAMED AHMAD AL-QASEM 55
YEARS PLD L3-4 RIGHT SIDE WITH LCS AT THIS LEVEL.
The patient came to the
clinic 09-November-2008 complaining of right
sciatica for one year. Exacerbation of the same
sciatica since 06-October-2008 after lifting
The patient underwent
discectomy L2-3 for left sciatica 2001
On examination: the patient
is limping with agonizing pain with exaggerated scoliotic stance,
with SLRS 40 degrees in the right and 45 degrees
in the left shooting to right with weak planterflexion and
dorsiflexion 4/5 right foot.
MRI lumbar spine performed
11-November-2008 ruling out recurrence and
confirming the de novo extrusion of L3-4 causing
segmental stenosis at this level.
Skeletonization of L3 and L4
laminae, using image-intensifier.
Laminectomy of L3 was performed and the upper edge
of L4 with foraminotomy of right L4 root. The
extruded disc was removed and cleaning of the
L3-4 disc space was performed from the right.
Smooth recovery with prompt
improvement of the power of right foot.
The patient was operated 7
years ago and dissection of many level was
performed even the level of L1-2, leaving a lot
of scar with long skin incision. Using
image-intensifier, not only minimize the
operative time, but it is also necessary to
prevent the wrong level.
All these elements must be
corrected during surgery. The segmental stenosis
was resolved and the extruded disc was removed
and the stenotic foramen of right L4 root was
The estimated recurrence rate
in this case is below 7%, because the disc space
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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