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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20-JANUARY-2008 FUAD AHMAD KHADER 41 YEARS HUGE RIGHT
FAR-LATERAL L5-S1 DISC EXTRUSION AND LEFT UPWARD MIGRATION.
The patient came to the
clinic 15-January-2008 complaining of right hip
pain for 25 days with right sciatica down to
right L5 territory.
MRI lumbar spine performed
09-January-2008 demonstrating extruded disc
L5-S1 with right huge far-lateral disc
protrusion and left upward migration. The
patient cannot walk more than 20 meters.
On examination: SLRS
was 80 degrees in the right and 90 degrees in
the left. with weak dorsiflexion both feet 4/5,
and hypalgesia right L5 territory.
The patient was advised to
keep in conservative treatment in the hope, that
the far-lateral extrusion can get a shift or
The patient could not wait
and the pain became agonizing, that another MRI
was performed 19-January-2008 confirming, that
the lesion still the same.
Bilateral flavotomy of L5-S1
was done. It was so wide, that, it was necessary
to use the image-intensifier, the level was
identified and the right far-lateral extrusion
was seen and a huge amount of extrusion was
removed. The left upward migrating material was
attacked from the left side and removed.
Bilateral meticulous cleaning
of the disc space was achieved.
Routine closure of the wound.
Smooth postoperative recovery
and the power of both feet dorsiflexion
The patient had very wide
space between L5 and S1. Usually we do not use
the image-intensifier to localize the level at
L5-S1, but in this case to avoid further bony
removal and waist of time image intensifier was
used to define the level.
Meticulous bilateral cleaning
with relatively small height of the disc space
are lowering the estimated recurrence rate in
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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