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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14-NOVEMBER-2012 BASSAM TAHSEEN AL-BITAR 50 YEARS
EXTRUDED DISC L4-5 WITH RIGHT UPWARD MIGRATION.
Anamnesis
The patient came to the clinic 11-November-2012
complaining of LBP and right sciatica for 1
month.
MRI of the lumbar spine done 11-November-2012
showing huge extruded disc L4-5 with right
upward migration and bulge L5-S1.
On examination: the patient is limping with
exaggerated scoliotic stance. SLRS 85 degrees in
the right
with pain. There is
weak dorsiflexion right foot 4/5.
Using image-intensifier, to
achieve approach through minimal incision, the
L4-5 level was identified. Partial right L4
hemilaminectomy with foraminotomy right L5 root.
The extruded disc L4-5 was removed lateral to
the axilla. It was necessary to incise the
posterior longitudinal ligament to expose the
far upward migrating disc so as to remove the
extrusion. 2 huge pieces came out and several
small fragments. Inspection of the right L4 root territory
to rule out remnants of any fragments. Right
sided cleaning of L4-5 disc space was achieved.
Routine closure of the wounds. Smooth
postoperative recovery. The power of the right
foot
became normal.
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Comments
The patient still has an
estimated postoperative recurrence around 7%,
because the disc space is still not shallow.
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