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-JUNE-2009 HASAN ABEDRABOH MUHAMED 40 YEARS
HUGE EXTRUDED DISC L4-5 WITH LEFT FAR DOWNWARD MIGRATION.
The patient came to the
clinic 15-June-2009 complaining of left sciatica the last
6 months with exacerbation of sciatica the last
3 days making him unable to sleep.
MRI lumbar spine performed
02-April-2009 showing extruded disc L4-5 with
left downward migration.
On examination: the patient
was limping with exaggerated scoliotic stance
and weak dorsiflexion left foot 4/5 . SLRS was 90
degrees with pain in the left. The patient was
sent to another MRI which showed further
enlargement of the disc.
Using image-intensifier, the
L4-5 level was identified. Left L5 foraminotomy
was performed after performing left L4
hemilaminectomy. The extruded disc was removed
from under the axilla and meticulous cleaning of L4-5
disc space was achieved from the left lateral to
the axilla. Routine
closure of the wound
Smooth postoperative recovery
with improvement of the power of the left foot.
The patient still having
considerable height of the disc space, which
make the expectation of recurrence higher than
So as to avoid dramatic
clinical deterioration in case of possible
recurrence the foraminotomy was extended more
down to have ample to the root in case of
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .