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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01-APRIL-2013 HAIFA MAHMOUD MAJEED 45
YEARS HUGE EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
The patient came
to the clinic 27-April-2005 complaining of pain
left wrist with hypalgesia of the thumb and
index left hand and weak grip left hand and left
triceps muscle. She had also weak dorsiflexion
right foot with hypalgesia right L5 territory.
The patient was sent for investigations and
given medications and disappeared.
The patient then came 30-March-2013 complaining
for 45 days with left sciatica down to the big toe
MRI lumbar spine done 27-February-2013 showing
huge extruded disc L5-S1 with left downward
migration. The patient telling that her
condition further deteriorated the last 2 days.
On examination: The patient is in agonizing
with exaggerated scoliotic stance. SLRS was 75
degrees in the right with pain shooting to the
left leg and 40 degrees in the left
with more pain. There is
weak dorsi and planterflexion left foot 2/5 with hypalgesia
left S1 root. The left KJ is less than the
The patient was sent for further investigations,
which confirmed the presence of huge extrusion
L5-S1 with left foraminal occlusion with left
The level of
L5-S1 was identified. Left partial L5-S1 flavotomy and foraminotomy
left S1 root
was done. The
extruded extrusion was
removed from under the axilla in one piece. Left sided
intradiscal cleaning L5-S1 disc space.
Routine closure of the wound.
Smooth postoperative recovery. The power of
the left foot became normal.
There is still an estimated postoperative
recurrence around 7%, because the disc space is
still not shallow.
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