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
neurosurgery.tv
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28-OCTOBER-2009 AHMAD BADER SADER 39 YEARS RECURRENT PLD
L4-5 LEFT SIDE WITH MASSIVE EXTRUSION.
Anamnesis:
The patient was operated by
me 30-August-2008
for PLD L4-5 with left downward migration. He
was doing well until he came 12-March-2009
complaining of LBP with scoliotic stance. MRI
performed 10-March-2009 showed small recurrence
which was treated conservatively.
The patient then came
07-October-2009 claiming that he improved in 90%
but still having scoliotic stance and left
sciatica.
MRI lumbar spine performed
22-October-2009 showing huge extruded recurrent disc
L4-5 with left downward migration.
On examination: the patient
was neurologically free, but surgery was
advised.
Refreshment of the left L5
root was achieved and the huge extruded disc was
removed in several pieces intentionally to
prevent root damage. Cleaning of the L4-5 disc
space was performed and PEEK Satellite nucleus
replacement sphere No 12 was inserted, which
reduced the collapsed disc space to the previous
normal height. All the stage were controlled
using image-intensifier.
Routine closure of the wound
and smooth postoperative recovery.
Comments
Insertion of PEEK Satellite
nucleus replacement sphere in this case giving
two advantages: preventing third recurrence and
bring back acceptable alignment of the disc
shape avoiding during that the stress in the
L4-5 facets both sides.
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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 .
