Dr. Ali Al-Bayati

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  neurosurgery.tv


The patient  came to the clinic 22-May-2005 with a history of LBP for 10 years. He had left sciatica the last week. MRI done 18-October-2004 showed moderate extrusion of L3-4 with left downward migration and bulging L4-5 disc. He was limping with scoliotic stance  with left SLRS 20 degrees and weak dorsiflexion all toes left foot with hypalgesia below the left knee. The patient was advised to undergo surgery, but he disappeared.

The patient then came 19-February-2006 with MRI performed 23-May-2005 showing huge extrusion of the L3-4 disc. His neurological status was worst with weak quadriceps of the left leg and hypalgesia above the left knee and SLRS 10 degrees in the left side. The patient was sent for another MRI, which confirmed the still present huge fragment of the migrating disc material at the same location and he was advised to undergo surgery.

The patient was operated. Left L3-4 hemiflavotomy and foraminotomy of the left L4 root was performed. The extruded disc was removed lateral to the root. It was adherent to the dural sac, but complete removal of the extrusion was achieved.

Inspection of the lateral wall of the annulus fibrosis, revealed, that it is intact,  for what the defect, through which the extrusion took place was sought and found and minimal cleaning of the disc space was performed.

Routine closure of the wound and the power of the lower limb recovered upon his recovery from anaesthesia.


1. In this case, in the contrary to the previous case. it was possible to remove the extruded migrated disc and to make minimal cleaning of the disc space without enlarging the defect, through which the extrusion took place.

2. Inspection of the annulus fibrosis was that, it will not cause sciatica to the patient and it will give barrier for further slippage of the intradiscal fragments.

3. Not all the time the disc material degenerate and shrink over even a long period of time, as in this case. In other cases, when patients coming after long period of time with disappearance of the fragment, the patient  continue to suffer from the irreversible damage to roots and in this case surgery will be of no benefit.


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved