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-OCTOBER-2008 ABEER JAMAL MIHYAR 39 YEARS
EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
The patient came to the
clinic 06-September-2008 complaining of left
sciatica for 5 months with exacerbation the last
month. The patient has polycystic kidneys and
arterial hypertension for 10 years.
On examination: the patient
is limping with exaggerated scoliotic stance
with SLRS 30 degrees in the left with pain and
almost drop left foot and weak planterflexion
left foot 4/5.
MRI lumbar spine was
performed 16-August-2008 showing extruded disc
L5-S1 with left downward migration.
Left partial flavotomy of
L5-S1 was done and foraminotomy of left S1 root.
The extruded disc was removed from under the
axilla, after what the laterally compressed S1
root became lax. The lateral dural wall of the
root was adherent to the ligamentous structures
confirming the long-standing presence of the
problem. The disc space was cleaned from under
the axilla and lateral to the axilla. Meticulous
cleaning was achieved from the left side.
Smooth recovery with prompt
improvement of the power of the left foot.
The patient has severe
compression of the root by the downward
migrating big piece. In this situation only
surgery can resolve the problem.
The degree of improvement
will depend upon the recovery of the root, which
depend upon the preoperative damage of the root
and the time delay since the occurrence of the
The expected recurrence rate
in this case is around the average, because the
disc space height still considerable and the
defect in the annulus fibrosis is not small.
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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 .