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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25-MAY-2011 ISMAEEL KHADER HAMMADY 41 YEARS
EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
The
patient came to the clinic 10-May-2011
complaining of LBP for 5 years with left sciatica for
5 months and numbness little toe left foot.
MRI lumbar
spine performed 05-May-2011 showing extruded
disc L5-S1 with left downward migration. MRI was
performed earlier in 19-February-2011 showing
the same picture.
On
examination: the patient is limping with
exaggerated scoliotic stance. SLRS was 70
degrees with pain in the left. There is weak
dorsi and planterflexion left foot 4/5 worse in
dorsiflexion. There is hypalgesia left S1
territory.
Left S1 foraminotomy with exposure of the
subaxillary area 10 mm below the axilla. The
extruded disc was adherent with the root. The
extruded disc was removed lateral to the axilla
and subaxillary. It was necessary to sharply
dissect the stuck adherent extrusion off the
root. Some tiny fragments were stuck to the
corner of the axilla, which were left in place
to avoid tear of the root.
Routine
closure of the wound. The sciatica
disappeared and the power of the left foot
regained full power.
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Comments
The patient came with neglected extrusion over
the years, that the extrusion was stuck with
dura, and it was necessary to perform sharp
dissection to regain proper discectomy.
The estimated recurrence rate is below 7%
because the disc space was shallow.
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 .
