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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12-DECEMBER-2013 KHALED MAHMOUD SHAHEEN 51 YEARS
EXTRUDED DISC L4-5 WITH RIGHT UP AND DOWNWARD MIGRATION.
The patient came to the emergency of Shmaisani
hospital with agonizing LBP and right sciatica
down to right L5 territory for 10 days, that he
could not sleep during this period due to pain.
The patient is a known diabetic for 2 years. He
came 05-March-2013 to the clinic with same
complains but with lesser degree of pain and MRI
lumbar spine done 02-March-2013 showed bulge
disc L4-5 and L5-S1 and the patient was treated
conservatively and he improved. MRI lumbar spine
done recently in 09-December-2013 showing
extruded disc L4-5 with right up and downward
On examination is limping, in agonizing pain with exaggerated
scoliotic stance. SLRS was 80
degrees both sides without pain. There is almost
drop right foot -3/5.
Using C-arm, the L4-5 level
was identified and lower 2/3 of L4 and upper 1/3
of L5 laminae were drilled out with foraminotomy
of right L5 root. The extruded disc was adherent
to the axilla and it was removed with sharp
dissection. The far upward migrating piece was
near the axilla of the right L4 root. It was
removed in one big piece. Inspection for any
remnants was negative and the disc space of L4-5
was cleaned from the right. Routine closure of the
recovery. The power of the right foot became
normal and the agonizing right sciatica
The estimated postoperative recurrence of L4-5
is still around 7%, because the disc space is
still not completely shallow.
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