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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27-JANUARY-2012 ABDEL-SALAM ALI ALKIKY 54 YEARS HUGE
EXTRUDED DISC L4-5 WITH LEFT FORAMINAL OCCLUSION.
patient came to the clinic 24-January-2012 complaining of LBP
with agonizing left sciatica. The patient is
Libyan citizen, during the civil was got
shrapnel's to the back and right gluteal area
12-September-2011. The patient 3 weeks later got
agonizing left sciatica with drop left foot. The
patient performed pelvis X-ray showing 2
shrapnel's in the right gluteal area in
subcutaneous layer. MRI lumbar spine performed
22-January-2012 showing huge extruded disc L4-5
with left foraminal occlusion with severe
segmental stenosis and occlusion of the left S1
examination, the patient is limping with
exaggerated scoliotic stance. SLRS
was 20 degrees with pain the left side. There is
left sided hemihypalgesia with sight
weakness of the left upper limb and complete
drop left foot with weak planterflexion left
foot 2/5 and weak left quadriceps femoris 4/5.
On inspection of the head there was hyperostosis
of the right parietal region.
MRI of the
brain done 25-January-2012 showing only the
scalp lesion without intracranial involvement.
CT-scan of the pelvis ruled out the presence of
any lesions at the trajectory of the left
Complete laminectomy L5 and
partial of L4. Foraminotomy L5 and S1 roots
achieved in the left side. The
left L5 root is severely compressed. The
extruded disc was hard in consistency and it was
removed partially lateral to the axilla and
partially subaxillary. Left sided cleaning of
L4-5 disc space. The root is hanging free.
Inspection of the L5-S1 annulus fibrosis showed
no fragment mobility and it was hard in
consistency, for what it was decided not to
violate the disc space.
closure of the wounds. Smooth postoperative
recovery with improvement of the power of the
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The patient is having estimated postoperative
recurrence around 7%, because the disc space
height still not narrow.
The patient has severe neurologic impairment and
the recovery period will last for long time with
unknown degree of improvement.
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 .