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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21-DECEMBER-2008 ZAYED MUHAMED AL-HALAYQEH 43
YEARS HUGE RECURRENT PLD L4-5 LEFT SIDE.
The patient came to the
clinic 01-November-2008 complaining of LBP and left sciatica
which persisted after performing discectomy L4-5
On examination: the patient
has exaggerated scoliotic stance. SLRS
was 85 degrees both sides. He had weak dorsiflexion
left foot 4/5. Hypalgesia left L5
MRI of the lumbar spine with
MRMyelography was performed 02-December-2008
showing huge recurrent disc L4-5 with left
Using image-intensifier, the
L4-5 level was identified and drilling of the
upper left corner of the bony defect was
performed. There was a lot of adhesion and the
disc space was reached lateral to the left L5
root axilla. Cleaning of L4-5 was performed.
after what the downward migrating piece was
pushed to the disc space and removed in one
block. There was a lot of adhesion around the
root and trying to minimize the scar was
achieved. Inspection of the dura anterior to the
axilla could show a tiny dural defect less than
0.5 mm with intact arachnoid with no CSF leak.
It was coagulated by bipolar to shrink and seal
it. Routine closure of the wound with
water-tight multilayer stitching to prevent
possible postoperative CSF leak.
Smooth postoperative recovery
and the power of left foot normalized.
Recurrence still a dilemma,
which needs proper solution in lumbar disc
surgery. Key-hole surgery will provide higher
recurrence rate and the patient will suffer
clinically after surgery.
The expected recurrence rate
in this case is still around the average, because the
disc space height still not shallow.
In case of recurrence and
adhesions, it is mandatory to look for dural
defects and tears, so as to manage them
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