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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25-AUGUST-2008 HAFITHA MUNEEB SHADEED 70 YEARS
LUMBAR CANAL STENOSIS WITH LEFT EXTRUDED DISC AT L4-5.
The patient came to the
clinic 18-August-2008 complaining of LBP for 10
years with exacerbation the last 2months and
right sciatica. She was walking with help of two
persons with bended posture.
The patient is a known
diabetic insulin-dependent for 20 years with
arterial hypertension for 10 years and
hypothyroid in L-thyroxin 100 microgram daily.
MRI performed 09-August-2008
showed lumbar canal stenosis with left extruded
On examination: the patient
is unable to walk with scoliotic stance with
weak dorsiflexion both feet 3/4 and
shooting left sciatica.
Decompressive Laminectomy L4
and partial of L5 was done. Bilateral foraminotomy of
both L5 roots was performed and the ligamentum
flavum was severely adherent to the dura, that
some parts were left in the posterior aspect
after removing the lateral portions. The
extruded disc was removed from under the left L5
root lateral to the axilla in several pieces.
Meticulous cleaning of the L4-5 disc space was
achieved from the left.
Routine closure of the wound
and smooth postoperative recovery.
The patient has old stable
spondylolisthesis L4-5 with multiple bony
deformities at the spinous process and lateral
facet joints, the it was necessary to use the
image-intensifier to localize the L4-5 level,
which was in parallel to the adherent ligamentum
The disc space was not
shallow, which could give the estimated
recurrence around 7%
Considering that the patient
has diabetes mellitus, monopolar dissection was
avoided to decrease the thermal injury to the
soft tissues and decrease the expected rate of
postoperative infection. In this case we usually
use the No11 blade.
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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 .