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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27-DECEMBER-2008 MANAL MUHAMED ABU-HIJLEH 42 YEARS
HUGE OLD RECURRENT PLD L4-5 LEFT SIDE.
The patient came to the
clinic 25-December-2008 complaining of LBP and
which took place 18 months after performing discectomy L4-5
On examination: the patient
has exaggerated scoliotic stance. SLRS
was 20 degrees both sides with agonizing pain
and she cannot sleep supine. She had weak dorsi
and planterflexion both feet 4/5 with numbness
all toes both feet.
MRI of the lumbar spine with
MRMyelography was performed 06-September-2008
showing huge recurrent disc L4-5 left side.
Considering that the patient
pain increased in the right side after the
performed MRI another MRI was requested and done
The patient is a known
diabetic and hypertensive and under treatment
with Imuran for hypertrophic glomerulonephritis
for 6 months. Stinting of the coronary artery
was performed 1 month ago.
The patient was admitted one
day before surgery and mega doses of Vit C and
multivitamins were given to avoid possible wound
dehiscence after surgery.
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 calcified extruded disc was
removed in several pieces. There was a lot of adhesion around the
root and trying to minimize the scar was
achieved. Routine closure of the wound with
water-tight multilayer stitching.
Smooth postoperative recovery
and the power of both feet normalized.
Recurrence still a dilemma,
which needs proper solution in lumbar disc
surgery. The patient had signs of recurrence 6
years without improvement.
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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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .