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-OCTOBER-2011 IBRAHEEM SAEED AL-NIDAWEE 63 YEARS
HUGE EXTRUDED DISC L4-5 MORE TO THE LEFT WITH COMPLETE SEGMENTAL STENOSIS.
patient was operated by me 21-August-2002 for
huge PCD C6-7 causing malacia of the spinal cord
and recovered after then. The patient then came to the clinic
complaining of LBP with left sciatica for 3
months. He could walk only 300 meter with
spine performed 18-August-2011 showing huge
extruded disc L4-5 more to the left with severe
examination: the patient is limping with
exaggerated scoliotic stance. There is weak
dorsi and planterflexion left foot 4/5. There is
dyseasthesia left L5 and S1 territories. SLRS
was 40 degrees with pain in the left.
Decompressive partial laminectomy of L4 and L5.
Bilateral flavotomy with bilateral L5
foraminotomy with more extension to the left L5
root. The extruded disc was removed from under
the left L5 root and left sided cleaning was
performed. Right sided cleaning of L4-5 disc
space was done until all the possible removable
disc fragments were achieved. The epidural fat
was missing in the left side of the dural
closure of the wound. Smooth postoperative
recovery with improvement of the power of both
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The patient has huge extruded disc which will
not resolve, until surgical decompression is
The estimated postoperative recurrence rate in
this case is around 7% because the disc
height still not shallow.
When huge disc with severe stenosis, it is
preferable to perform bilateral cleaning to
minimize the recurrence rate and to decrease the
height of the disc space symmetrically.
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 .