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-MAY-2008 HANIN RASHEED AL-MASRI 51 YEARS
EXTRUDED DISC L5-S1 WITH RIGHT SUBAXILLARY MIGRATION.
The patient was seen by me
08-October-2006 for LBP and right sciatica down
to L5 territory with MRI of
the lumbar spine done 17-September-2006 demonstrating slight extruded
disc L5-S1, which was treated conservatively.
The patient came to the
emergency of Al-Shmaisani hospital 30-May-2008 complaining of LBP with
sciatica for 3 days. Exacerbation of sciatica
the last 3 days with limping and difficult
walking and positive cough sign.
MRI lumbar spine performed
30-May-2008 showed extruded disc L5-S1 with
right downward migration.
On examination: the patient
in agonizing pain with exaggerated scoliotic
stance and inability to walk. SLRS was 25 degrees in the left with
pain and 5 degrees in the right. There was weak dorsi and planterflexion
right foot 3/5, hypalgesia right L5 and S1 roots
territory with absent AJ right side.
Right L5-S1 hemiflavotomy with
foraminotomy of right S1 root was performed. The
extruded disc was removed from under the axilla.
Meticulous cleaning of the disc space from the
right side. Inspection under the axilla and the
foramen for remnants.
The epidural fat was kept
untouched through the operation.
Routine closure of the wound
with prompt recovery of the power of left foot.
The recurrence rate is above
7% in this case, because the disc space still
not shallow and the defect in the annulus fibrosis
is medium in size.
Preserving the epidural fat
minimize the incidence of postoperative
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