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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
31-JULY-2010 BILAL NAFETH SALEH NASER 32 YEARS
HUGE EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
to the clinic 29-July-2010 complaining of LBP
for 4 years with right sciatica for 4 months
down to the heel without improvement, despite
all measures including intrathecal
enzymotherapy, which was performed 01-June-2010.
MRI lumbar spine
performed 29-April-2010 showing huge extruded
disc L5-S1 with right downward migration.
On examination: the
patient is limping with very exaggerated
scoliotic stance with SLRS 20 degrees with pain
in the right and weak dorsi -4/5 and
planterflexion 4/5 of the right foot.
MRI of the lumbar
spine was repeated 29-July-2010 showing the same
Partial flavotomy L5-S1 right side was done.
Foraminotomy of S1 root was achieved. The
epidural fat was rubbery in consistency due to
previous epidural enzymo-therapy. The extruded
disc was removed in several pieces after what
the the root regained relaxed position.
Meticulous cleaning of the L5-S1 disc space from
Smooth postoperative recovery and normalization of the power of right
This case is the 10th case
after enzymotherapy. The cases were put under
careful study and at various periods of time.
It seems that enzymotherapy is useless and it
harm the epidural tissue, which can minimize the
recovery in the postoperative period. This
modality of treatment must be stopped, because
it is not effective and useless.
It happens that huge
extrusions shrink by time, but this depends upon
the water content of the extruded fragment,
which could be caught by the MRI data. If the
extrusion is white, it means that it is fresh
and watery. These cases shrink in more than 80%
of cases. If the fragment is medium gray, then
the percent of shrinking will be around 40%. If
the extrusion is gray-dark, then the possibility
of shrinking is minimal.
The expected recurrence rate
in this case is more than 7% because the defect
in the annulus fibrosis is wide and the disc
space is still not shallow.
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 .