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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13-NOVEMBER-2008 ALI HASAN AMER 37 YEARS
HUGE EXTRUDED DISC L4-5 WITH UPWARD MIGRATION MORE TO RIGHT.
Anamnesis:
The patient came to the
clinic 11-November-2008 complaining of LBP for 2
months with right sciatica with numbness of the
second and third toes right foot.
The patient suffered RTA 15
years ago after what he started to complain of
LBP.
MRI lumbar spine performed
02-November-2008 showed huge extruded disc L4-5
with upward migration more to the right.
On examination: the patient
is limping with exaggerated scoliotic stance,
with weak planterflexion both feet 4/5 and
dorsiflexion -4/5 .
Skeletonization of L4 and L5
laminae revealed fracture of isthmi both sides.
Laminectomy of L4 was performed the upper edge
of L5 with bilateral foraminotomy. The bony
extrusion was removed from both sides and
meticulous bilateral cleaning of L4-5 disc space
was achieved. The harvested bone was milled and
the bony dust was impacted in the disc space.
Smooth recovery with prompt
improvement of the power of both feet.
Please! wait for 3-5 min till the
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Comments
The patient denying recent
injury to the spine. It could be caused by the
old RTA 15 years ago. These finding of fracture
of both isthmi were discovered during surgery.
All these elements must be
corrected during surgery. Instead of using
transpedicular fixation, the bone dust was
impacted to the disc space and the patient will
be kept in corset for 6-7 months after surgery.
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 .
