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-2012 AFAF IBRAHEEM
ABBAS 51 YEARS RECURRENT DISC L5-S1.
patient was operated by me
for wide-based extruded disc L5-S1. The patient
the third postoperative day started to complain
of agonizing right sciatica which continued to
escalate the following days.
of the lumbar spine was performed
19-January-2012 confirming the presence of
recurrence at the same level with a hard piece
separated from the disc space at the right S1
axilla. Considering that the patient is in
agonizing sciatica she was planned for revision.
The wound was opened and the
right S1 root was surrounded by massive
inflammatory fibrotic tissues. Scarolysis was
done and the root was swollen. Annulotomy was
performed lateral to the root and subaxillary,
until the root was free of any compression.
Inspection around the root was negative. A hard
annulus fibrosis fragment was stuck to the dura
medial to the axilla. It was sharply dissected
from the dura. Using high-speed drill the bony
edges of the upper border of S1 and lower border
of L5 was drilled out from the right 2/3 of the
area, so as to ensure that no annulus remnants
were left behind. Further inspection of the area
confirmed no presence of any fragments left
behind intra, extradural or inside the swollen
closure of the wounds. Smooth postoperative
recovery with decrease of the right sciatica.
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The patient still having recurrence rate below
7% because the disc space is slightly shallow,
even with annulotomy performed.
The swollen root me play a role in pain
generation. The postoperative course will give
Here, it is not a true recurrence, but the hard
piece of the annulus fibrosis, stuck to the dura
gave the false impression of recurrence. The
agonizing sciatica enforced for reoperation.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .