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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05-NOVEMBER-2014 AMNEH AREF MUSTAFA 50 YEARS
EXTRUDED DISC L1-2 LEFT SIDE WITH WIDE-BASED EXTRUSION L4-5 WITH SEVERE
STENOSIS BOTH LEVELS.
came to the clinic 04-November-2014 complaining of LBP
with bilateral sciatica for 2 years with
exacerbation last 5 months with drop left foot
for this period. CT-scan of the spine done twice
On examination, the patient is limping with
exaggerated scoliotic stance. There is pain when
turning the head to the right, up and downward.
There is weak grip left hand 3/5, extension both
hands 3/5 and both triceps muscles 3/5. SLRS was
degrees with pain in the right and 50 degrees
with pain in the left. The left foot is
completely drop with weak planterflexion left
foot -3/5. Weak dorsiflexion right foot 2/5 and
planterflexion same foot 4/5. There is analgesia
left L5 root with hypalgesia left S1 root. Weak
both quadriceps 3/5. Loss of hearing left ear
for 6 years.
The patient was sent for investigations and done
the same day. MRI of the brain was normal. MRI
of the cervical spine showed PCD C5-6
wide-based, not compressing the spinal cord. MRI
lumbar spine showing huge extruded disc L1-2
more to the left causing severe stenosis. Severe
stenosis of L4-5 with wide extrusion. Dynamic
studies were normal.
Using the C-arm, the L1-2 level was identified.
Left L1-2 hemiflavotomy was performed with
drilling to achieve exposure of the area without
applying traction of the spinal cord. The
extruded disc was identified and removed.
Intradiscal cleaning L1-2. Through another
separate incision, decompressive laminectomy L4
and upper 1/3 of L5 was achieved. Foraminotomy
both L5 roots was performed. Inspection of the
annulus fibrosis revealed that it is better not
to violate the intradiscal structures. Further
foraminotomy of the left L5 root to ensure that
no additional compression was present in its
Routine closure of the
Smooth postoperative recovery.
The power of the right foot became normal and
the planterflexion of the left foot became
normal. The drop left foot remained the same.
The patient still has an estimated
postoperative recurrence around 15%, because the disc spaces
still not completely shallow.
It is rarely to see recovery of complete
drop for when it has place for long time. Time will show if
this case could be an exclusion.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
Inomed MER system
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 .