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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19-JUNE-2013 BASSAM MUHAMED BTEIT 39 YEARS
EXTRUDED DISC L4-5 WITH UPWARD MIGRATION BILATERAL MORE TO THE RIGHT.
The patient came
to the clinic 18-June-2013 complaining of LBP
with left sciatica for 15 years. The last week
got exacerbation of LBP with bilateral sciatica
more the right with numbness all toes right foot
and positive cough sign.
MRI lumbar spine done 16-June-2013 showing huge
extruded disc L4-5 with upward migration
bilateral more to the right. There is old bulge
On examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 75
degrees with more pain in the right. Weak
dorsiflexion right foot -4/5 and left foot 4/5.
Weak planterflexion right foot 3/5. There is
hypalgesia both L5 roots and right S1
Bilateral L4-5 flavotomy and
foraminotomy both L5 roots. The extruded disc
had 2 components, the soft part in the right
side and hard part in the left side, and they were attacked first from the right side and the
upward migrating disc was removed. Inspection of
the left side showed more severe extrusion,
which was removed lateral to the left L5 axilla.
After removal of the huge extrusion from the
left side a pin point CSF leak took place. The
pin point dural defect located at the upper
border of the left L5 axilla was closed by nylon
Zero applying one stitch. Check for CSF with Valsalva maneuver and
elevation of the head was negative. Bilateral
cleaning of L4-5 disc space was carried on.
Routine closure of the wound.
Smooth postoperative recovery.
The power of both feet dorsiflexion became normal
and slight improvement of the planterflexion
The patient still has an estimated postoperative
recurrence around 7%, because the disc space is
still not shallow, even with bilateral cleaning.
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