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18-APRIL-2004 ABDEL-KAREEM YOUSEF SALEEM 44
YEARS CENTRAL EXTRUDED DISC L5-S1.
Anamnesis
The patient came to the
clinic 14-April-2004 complaining of LBP with
bilateral sciatica more to the left for 2 years
with exacerbation of the pain last month with
positive cough sign. MRI lumbar spine done
10-April-2002 showing bulge L4-5 and small
extrusion L5-S1 touching the left S1 root. MRI
repeated 07-April-2004 showing dehydration of
L4-5 with huge extruded disc L5-S1 with left
downward migration.
On examination, the patient in agonizing pain,
limping with exaggerated scoliotic stance with
weak dorsiflexion both feet, more the left. SLRS was
80 degrees both sides with
pain.
Foraminotomy left S1
roots was achieved. Left sided intradiscal cleaning L5-S1 was
performed.
The patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. A free fat was
harvested from the
subcutaneous layer and covered the exposed parts
of the dura and roots to minimize postoperative
scarring. Routine closure
of the wound.
Smooth postoperative recovery. The power of both
feet normalized.
FOLLOW UP
The patient
came to the clinic 01-May-2004 with clean wound
and no motor, nor sensory deficit.
The patient
then came 30-December-2004 telling that 3 days ago
had kidney stone with back pain without sciatica. He
was neurologically free. He was treated
conservatively.
Comments
There is still an
estimated postoperative recurrence around 7%,
because the disc space is still not completely
collapsed.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
fixation is the most accurate system in the market. The microdrive and
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Inomed MER system
Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
LooksCam II Xenosys in the run starting from 14-March-2021 with
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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 .
