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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03-APRIL-2013 FAHED GHAZI AL-SHAMMARY
55 YEARS HUGE RECURRENCE OF L4-5 MORE TO RIGHT.
The patient came
to the clinic 02-April-2013 complaining of LBP
with bilateral sciatica more to the right with
numbness of the right foot. The patient was
operated elsewhere 26-August-2012 for extruded
disc L4-5 after what he improved to start suffer
of the same pain after 2 months with escalation
of the bilateral sciatica the last 2 weeks.
MRI lumbar spine done 23-December-2012 showing
huge recurrence of L4-5 more to the right. MRI
repeated 24-March-2013 showing total collapse of
the L4-5 disc space with bigger extrusion of the
On examination: The patient is limping
with exaggerated scoliotic stance. SLRS was 60
degrees in the right with pain and 80 degrees in the left
without pain. There is
weak dorsiflexion both feet -4/5 and planterflexion
right foot 4/5.
The old wound refreshed and
scarolysis of the right side with foraminotomy
of the right L5 root. The root was followed up
until the most right part of the extrusion was
found. It was so huge that it was removed in
several pieces intentionally, to prevent
traction trauma to the already traumatized root,
lateral to the axilla. The root and and dura
became lax after this removal. The collapsed
disc space was inspected and it was very shallow
and no disc material inside.
Routine closure of the wound.
Smooth postoperative recovery. The power of
both feet became normal.
There is an estimated postoperative
recurrence around 0%, because the disc space of
L4-5 suffered total collapse.
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