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-2011 SHIRIN MAHMOUD ATTALLA 48 YEARS HUGE EXTRUDED DISC
L5-S1 WITH RIGHT DOWNWARD MIGRATION.
patient came to the clinic 24-September-2011
complaining of LBP with right sciatica for 10
days with numb right foot.
spine performed 25-September-2011 showing huge
extruded disc L5-S1 with right downward
examination: the patient is limping, has
exaggerated scoliotic stance. There is weak dorsi
-4/5. SLRS was 75 degrees in right side
Using C-arm the level of
L5-S1 was identified and right S1 foraminotomy
with partial flavotomy of L5-S1 was done. The
extruded disc was removed lateral to the axilla
and parts by subaxillary route. Right sided
cleaning of L5-S1 disc space was achieved.
Some parts of the extrusion were hard in
consistency and were adherent to the anterior
wall of the root. Inspection for CSF leak was
done by putting the patient in head up position
with Valsalva maneuver. No CSF leak. The
epidural fat was preserved and reflected to the
missing parts of the root cover.
closure of the wound. Smooth postoperative
recovery with improvement of the power of
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The estimated postoperative recurrence in this
case is below 7%, because the disc space is
The patient was given Zinnat 500 mg twice daily
and Relaxon three times daily, Rapidus 50 mg
three times daily, Nexium 40 mg once daily,
Nucleo CMP twice daily and Celebrex 90 mg once
daily after discharge the second day after
The patient progressed the 4th postoperative day
the clinical picture of
Guillain-Barre syndrome, for what she
admitted and treated accordingly.
All medications were stopped and Solucortef 100
mg was given via i/v route three times a day
with Menopace and Perfalgan 1 gm i/v twice
daily. IGIV with Intratect 100 ml (5gm) was
administered 5 times a day starting form the
noon of 08-October-2011 for 5 days.
Concerning the drug induce or related
Guillain-Barre syndrome for more information
The patient was treated with 5 sessions of
plasmophoresis 2 weeks after slight improvement
after IGIV with subsequent deterioration and for
insurance reasons, permission for plasmophoresis
was approved when the patient was in ventilator.
The patient showed mild improvement and she was
discharges 25-November-2011 with still inability
to help herself to eat or ambulate. She was
bedridden and by telephone communication at
10-December-2011 the patient showed another
surge of deterioration.
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 .