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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28-SEPTEMBER-2009 FAYSAL MAHMOUD AZAZMEH 37 YEARS
HUGE EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
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The patient came to the
clinic 24-September-2009 complaining of LBP for
9 days with left sciatica for 5 days. MRI lumbar spine
performed 24-September-2009 showing extruded disc
L5-S1 with left downward migration.
The patient was limping with exaggerated scoliotic
stance with shooting left sciatica. SLRS
was 30 degrees in left side with pain. The
patient had weak dorsi and
planterflexion left foot 3/5 and analgesia of
the left S1 root and hypalgesia of left L5 root.
Left S1 foraminotomy was done
with reflection of the ligamentum flavum to the
right. The extruded disc was seen under the
axilla and it was pushing the root lateral. It
was removed in several pieces so as to avoid
further damage to the root. Inspection of the
root showed that the dura of the medial wall of
the root was damaged and CSF was coming out. It
was repaired with Nylon 6 zero.
The root was shifted medially
and meticulous cleaning of the L5-S1 disc space
was performed lateral to the axilla. PEEK
satellite nucleus replacement sphere 11 mm size
was inserted and pushed at the center of the
space with image intensifier.
Routine closure of the
wound and smooth
and the power of the
left foot normalized and the patient sent to
The disc space is still high
and the patient is young, for what PEEK sphere
was inserted to minimize the rate of
The dura was torn by the
extruded disc which was seen under the axilla
and pushed posteriorly. It was damaging the dura
at this location an it was repaired accordingly.
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 .