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
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02-DECEMBER-2009 HUSAM MUHAMED AHMAD 23 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
Anamnesis:
The patient
came to the clinic 21-November-2009
complaining of LBP with left sciatica for 5
years. The last 8 months exacerbation of
sciatica and inability to walk with shuffling
gait.
The patient was
limping with exaggerated scoliotic stance. SLRS
85 degrees in the right and 60 degrees in the
left. He had weak dorsiflexion left foot 4/4 and
planterflexion 3/5 with hypalgesia left S1 root.
MRI lumbar spine performed
22-November-2009 showing extruded disc L4-5
central more to the left with downward
migration.
Bilateral L4-5 flavotomy with
exposure of the compressed left L5 root.
There was no epidural fat due to severe
compression. Using image-intensifier during all
steps of surgery the level of L4-5 was confirmed
and the extruded disc was removed lateral to the
axilla of left L5 root. Meticulous cleaning of
the disc space of L4-5 was achieved from the
left.
PEEK Satellite nucleus
replacement sphere No 12 was inserted and check
in AP and lateral views was done confirming
acceptable position of the device.
Routine closure of the wound
and smooth postoperative recovery and
improvement of the power of left foot.
Comments
Recurrence of disc prolapse
is around 15% in this case because the disc
space is still high and the defect of the
annulus fibrosis is wide.
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Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
