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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22-SEPTEMBER-2008 KHAWLA ABDALLAH SAEED 44 YEARS
EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the
clinic 20-September-2008 complaining of LBP for
18 years with right sciatica. Exacerbation the
last two months of the right sciatica.
17-September-2008 showed extruded disc of
L4-5 with right downward migration and complete
occlusion of the right foramen.
On examination: the patient
in agonizing pain. Limping with scoliotic stance
with SLRS 45 degrees with pain right side. She had almost drop
right foot and
weak planterflexion left foot 4/5.
The patient is a known
diabetic and hypertensive with elements of
Right hemiflavotomy of L4-5
was done and foraminotomy of right L5 root was
achieved. The extruded with down migrating
piece was removed in several fragments.
Considering that the disc space still high and
the annulus fibrosis is not hard and there is
defect under the annulus, it was decided to
clean the L4-5 disc space meticulously from the
The defect of the annulus
fibrosis was wide, for what further cleaning was
Routine closure of the wound
and smooth postoperative recovery.
The patient had complete
obliteration of the right L4-5 foramen with
severe compression of the left L5 root. This
must be resolved by surgery.
The estimated recurrence in
this case is around the average -7%, because the
disc height is not shallow. Coagulation of the
defect of the annulus fibrosis decrease
the dimensions of the defect, which
theoretically could lead to lower the estimated
The patient having diabetes
mellitus, for what during surgery cutting
monopolar was avoided , instead using blade No
11 for bony dissection to minimize thermal
injury to the soft tissues, to decrease the
incidence of postoperative infection.
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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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