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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29-NOVEMBER-2008 IFTIKHAR TAWFEEQ ABDEEN 60 YEARS
PLD L4-5 MORE TO RIGHT WITH SECONDARY CANAL STENOSIS.
Anamnesis:
The patient came to the
clinic 01-August-2005 complaining of LBP for 9
years with right sciatica for the last 2 years.
MRI lumbar spine performed 05-November-2003
showed small PLD L3-4, 4-5 and L5-S1. The
patient at that time had scoliotic stance with
SLRS 75 degrees with pain in the right with weak
dorsiflexion all toes right foot. The patient is
a known diabetic for 4 years. The patient was
treated conservatively.
The patient then came
02-Aigist-2005 with exacerbation of right
sciatica and it was decided, that if no
improvement during a period of a month, then to
consider surgical treatment. The patient then
came to the clinic 10-September-2005, claiming
that she is not improving, but clinically she
was neurologically free for what conservative
treatment was planned.
The patient then came
04-June-2006 complaining of right sciatica for
the last 5 days with SLRS 45 degrees in the
right with pain with weak dorsi and
planterflexion right foot. New MRI done 05-June
2006 showing wide-based extrusion of L4-5 with
secondary segmental stenosis at this level.
She was advised to undergo surgical treatment,
but the patient disappeared.
The patient then came
25-November-2008 complaining of exacerbation of
LBP with bilateral sciatica, more the right the
last 45 days. MRI lumbar spine performed
15-Novemeber-2008 showing progression of the
segmental stenosis at L4-5 with the same
wide-based extrusion at the level.
On examination: the patient
has scoliotic stance and inability to walk more
than 150-200 meters and SLRS right side 60
degrees with pain. She had weak dorsi and
planterflexion both feet 4/5.
Decompressive laminectomy of
L4 and partial of L5 was performed. Bilateral
foraminotomy of bL5 roots was achieved. There was no epidural
fat at these levels. Bilateral cleaning of the
extruded disc L4-5 and cleaning of the disc
space, which was shallow.
Smooth recovery with
considerable improvement of the power of both
feet.
Comments
The patient had prolonged
history of LBP and sciatica and most of the time
conservative treatment was recommended. The
presence of the segmental stenosis, which was
progressing led to escalation of the problem and
to surgical treatment.
The extruded disc was
wide-based, for what bilateral cleaning of the
disc space was performed.
The expected recurrence rate
in this case is below 7%, since the disc space
was shallow and empty.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
