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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30-JANUARY-2010 ADNAN ISMAEEL JABER 40 YEARS EXTRUDED DISC
L5-S1 RIGHT SIDE.
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The patient came to the
clinic 20-March-2003 complaining of suspected
CSF leak which was ruled out. The patient then
came 06-January-2010 complaining of low back pain
for 1 year with right sciatica. Exacerbation of
right sciatica the last month.
On examination: the patient has
scoliotic stance with SLRS 70 degrees with pain
in the right with weal dorsiflexion both feet
06-January-2010 showing extruded disc L5-S1 huge
central more to the right.
image-intensifier the L5-S1 level was identified
and right hemiflavotomy L5-S1 with foraminotomy
of right S1 root was performed. The extruded
disc was removed lateral to the axilla and right
sided cleaning of L5-S1 was done from the right.
Satellite spinal system, it was necessary to use
sphere No 13 to have acceptable prerequisites
and check image-intensifier showed central
location of the device. The curette was
not used intentionally, so as not to harm the
endplate. Contrast was injected inside the disc
space from the right. It was noted that the
contrast media could not cross the right half to
the left. Using feeding tube to inject the
contrast to the left side also failed. It was
noticed that the sphere is not moving from its
position despite vigorous force applied, but it
was only rotating at its bed.
Routine closure of the wound.
recovery, with improvement of the power of both
The surgeon think
that he performed meticulous cleaning of the
disc space. The use of contrast in this case was
an illustration, that the disc remnants still
there. Even the contrast could not fill the gap
contra-lateral the excision and cleaning. This
means, that there is still layers of the disc
material behind the sphere.
The diameter of
the sphere is an indicator to the possible
postoperative estimated recurrence . The more
the diameter is parallel with the higher
recurrence , in case of not using the sphere.
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 .