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

24-AUGUST-2006  HANA JAMAL ABDEL-RAZZAQ  39 YEARS  RECURRENT PLD L5-S1 LEFT SIDE AFTER 16 YEARS. 

On examination: the patient is limping with agonizing pain and cannot  set on the chair  with SLRS 5 degrees in the left with absent Achill's reflex left side. weak planterflexion and almost drop left foot with hypalgesia left L5 and S1 territories.

The patient was sent to another MRI and performed 17-August-2006 , which confirmed recurrence at the site of the previous surgery from the left side.

Left S1 foraminotomy was done and the root was followed upward with minimal scar until the extrusion was seen severely compressing the nerve. It was impossible to elevate the root off the compression, for what it was decided to clean the intradiscal space and to push the extrusion to the disc space and from there to remove it. After that the root became lax and soft. Inspection of the axilla was negative.

The previously inserted fat graft in pedicle was bisected in 2 layers and reflected to cover the exposed root to minimize scar formation. 

Comments:

1. The patient was operated 16 years ago, when it was a common practice, to cover the dura with fat graft with pedicle, reflected to cover the dura and roots. Here is an example of good-looking fat inserted  16 years ago with good result. The fat was so soft, but a little harder than the epidural fat, but it provided the intended function from this maneuver . i.e., prevent scar formation and give elasticity to the neural structures, minimizing postoperative pain.

2. It is the first case in my series of recurrence with this long protracted period (16 years) of time.  The patient was in good condition all the time, but after lifting heavy object she started to suffer.

3. Do not hesitate to ask for new MRI, if the recently performed one not conforming with the clinical data. It happens, that the disc can change configuration within seconds, not speaking about days or weeks.