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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09-SEPTEMBER-2013 HAFEZ KHATTAB AL-HAMAYLEH 49
YEARS EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 07-September-2013
complaining of LBP with left sciatica for 3 months down to
all toes left
foot with numbness. He is a known diabetic with
glucophage 500 mg once a day. He is under
treatment for Mediterranean fever with
colchecine for 9 years.
MRI of the lumbar spine performed 17-July-2013
showing extruded disc L4-5 with
left downward migration and foraminal occlusion.
On examination: the patient is
limping with exaggerated scoliotic stance. There
is weak dorsiflexion left foot -3/5. SLRS was
70 degrees in the left without pain, and 30
degrees in the right with pain. There is
hypalgesia left L5 and S1 territories.
Using C-arm, the level of
L4-5 identified. L4-5 flavotomy with left L5
foraminotomy was done. The extruded disc was
removed lateral to the axilla of the right L5
root. Left sided cleaning L4-5 disc space. The
downward migrating extrusion was removed at the
end of surgery.
Smooth postoperative
recovery. The power of the left foot
became normal.
Comments
The patient still have an estimated
postoperative recurrence around 7% because the
disc space height still not shallow.
The SLRS was negative at the side and positive
at the contra-lateral side.
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