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 FAYSAL SHAMSI MUSA 38 YEARS
HUGE OLD PLD L5-S1 CENTRAL MORE TO THE LEFT WITH LUMBARIZATION OF THE SACRUM.
The patient came to the
clinic 14-August-2007 complaining of LBP and
left sciatica for three months
On examination: the patient
has exaggerated scoliotic stance. SLRS
was 20 degrees right side and 5 degrees in the
left with agonizing pain and. He had weak dorsi
and planterflexion left foot 3/5 with hypalgesia
left L5 root territory.
MRI of the lumbar spine with
MRMyelography was performed the next day and
huge extrusion of L5-S1 with lumbarization of
the sacrum was noted. The patient was advised to
undergo surgery, but he disappeared.
The patient then came
13-December-2008 with agonizing bilateral
sciatica for the last 20 days. He had weak both
feet with dorsi and planterflexion 3/5. He could
not stand upright and walked bended with the
help of two persons.
Considering that the patient
pain increased in the right side after the
performed MRI another MRI was requested and done
13-December-2008 which confirmed the persistence
of the huge disc L5-S1.
Bilateral L5-S1 flavotomy and
bilateral S1 foraminotomy was performed. There
was no epidural fat in the area due to severe
compression. The huge extruded disc was attacked
from the left side lateral to the axilla. The
extruded disc was removed in several pieces and
meticulous cleaning of the disc space was
performed from the left side. Inspection of the
right side showed no extrusion and the annulus
fibrosis was lax. Routine closure of the wound
with water-tight multilayer stitching.
Smooth postoperative recovery
and the power of both feet normalized.
Some patients with huge
extrusion escape surgery and around 20% of them
showing shrinkage of the extrusion, bypassing
surgery, but with high price. The damage to the
roots becoming permanent and surgery of no help.
The expected recurrence rate
in this case is still around the average, because the
disc space height still not shallow.
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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 .