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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31-JULY-2010 HUDA JUMA JAMIL HUSSEIN 38 YEARS
VERY HUGE EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.
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to the clinic 10-July-2010 complaining of LBP
for 2 years with right sciatica. Exacerbation of
the right sciatica the last 5 months. MRI lumbar
spine performed 26-August-2008 extruded disc
L4-5 and L5-S1 (bad quality).
On examination: the
patient start to limp after a while with
scoliotic stance. SLRS was 75 degrees in the
right with pain.
MRI of the lumbar
performed 11-July-2010 showing very huge
extruded disc L4-5 with right downward migration
and bulge L5-S1
Using image-intensifier the L4-5 level was
identified and dissection is carried out.
Another check of the level was carried out and
it was the L3-4 level, for what the dissection
was redirected to L4-5 level. Right side partial
flavotomy of L4-5 was done and foraminotomy of
the right L5 root was performed. There is no
epidural fat at the root territory due to severe
compression. The extruded disc was removed in
several pieces intentionally to avoid trauma to
the severely compressed and stretched root.
After removal of all the extrusion, meticulous
cleaning of L4-5 disc space was performed from
Smooth postoperative recovery and
improvement of the power of right foot.
This estimated postoperative
recurrence in this case is more than 7% because
the defect in the annulus fibrosis is wide and
the disc space is still not shallow.
When you suspect your level,
all the time use image-intensifier, to avoid
wasting time and prevent unnecessary dissection
and skeletonization. We are trying not to use
methylene blue, because it could trigger
possible postoperative infection or reactionary
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 .