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-JULY-2009 HUSNIEYH IBRAHEEM KHRAYES 70 YEARS
LUMBAR CANAL STENOSIS L3-4 AND L4-5 WITH LATERAL RECESS SYNDROME.
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The patient came to the
clinic 16-May-2009 complaining of LBP with right sciatica for
5 years with exacerbation of left sciatica the
last 4 days and inability to walk more than 20
meters. She is using crutches for 2 days.
She underwent open heart
surgery 10 years ago and has controlled diabetes
MRI lumbar spine performed 9-May-2009
showing lumbar canal stenosis L4-5 and L3-4.
On examination: the
patient is limping with
scoliotic stance, SLRS
was 45 degrees in the
right and 30 degrees in
the left side and
weak dorsi and planterflexion
left foot 3/5 and 4/5
laminectomy of L4,5 and
partial of L3 was done.
Foraminotomy both L5
roots was achieved with
special attention to the
left L5 root. It was
severely compressed by
the hypertrophied facet
and there was a tough
vein encircling the
root, which was
coagulated and bisected
to eliminate any
even if it is a vascular
component. The root
became free of any
compression over 12 mm
of distance from the
axilla. Inspection of
the L4-5 disc was
negative for any pain
for what it was left
untouched. The epidural
fat was missing at the
compressed sited. Routine
closure of the wound.
Smooth postoperative recovery
with improvement of the power of the feet.
Lumbar canal stenosis is a
progressive disease and surgery is mandatory
when it is progressing.
The cause of pain could be
not from the extruded disc , but it could be
from and extruded ganglion from the facet
or vascular compression, as in neuralgia. All
these factors must be taken into consideration
and eliminated 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 .