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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21-JULY-2010 IMAD ZAKARIYA AL-NATSHEH 32 YEARS
EXTRUDED DISC L4-5 WITH SEVERE SEGMENTAL STENOSIS.
Anamnesis
The
patient came
to the clinic 24-May-2010 complaining of
LBP with right sciatica for 4 years ,
which was previously in the left.
On examination: the
patient was limping with exaggerated scoliotic
stance. SLRS was 70 degrees in the right and 45
degrees in the left. There was hypalgesia above
the knee in the right and below the knee in the
left with weak dorsiflexion both feet 4/5 and
planterflexion right foot 4/5.
MRI done
25-May-2010 showing severe lumbar canal
stenosis L3-4 and L4-5 with extruded disc L4-5
more in the left.
Decompressive
laminectomy of L4 and partial of L5
with foraminotomy of L5 roots both
sides. There is no epidural fat and no
overmobility of the segments. Inspection of the
annulus fibrosis revealed the extrusion in the
left side, which was removed and the disc space
of L4-5 was removed from the left side. The
right side was inspected and it was decided not
to violate the annulus fibrosis from the right
side.
Routine closure of
the wound and smooth postoperative recovery.
The power of both
feet dramatically improved.
Comments
Lumbar canal stenosis is a
progressive disease and early surgical
intervention in case of progression avoid the
patient unnecessary possible complication..
Total decompression must be
performed including the canal and the roots. and
removal of the extrusion must be performed,
because in case of leaving it . it will extruded
more because there is plenty of space to extrude
further after the surgery.
The estimated recurrence rate
in this case is ranking around 7%, because the
disc space height still not shallow.
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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 .
