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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03-DECEMBER-2011 LANA MUHAMED HUSSEIN 32 YEARS
EXTRUDED DISC L4-5 WITH LEFT FAR DOWNWARD MIGRATION.
Anamnesis
The
patient was seen immediately before surgery with
clinical history of LBP for 4 years with left
sciatica for 3 weeks with numbness and pain down
to the big toe left foot.
MRI done
20-November-2011 showing huge far left downward
migrating disc L4-5 reaching the L5-S1 level
On
examination, the patient is limping with
exaggerated scoliotic stance. SLRS was 40
degrees in the left with pain. There is drop
left foot with weak planterflexion -4/5. There
is hypalgesia left L5 territory. Cough sign
positive.
Left L5 far down subaxillary approach was
achieved and the extruded disc L4-5 was
identified and attacked subaxillary. It was
removed in several pieces after what the
laterally compressed left L5 root was free of
any compression. Cleaning of the L4-5 disc space
was performed from the left side.
Routine
closure of the wound. Smooth postoperative
recovery with improvement of the power of
the left foot.
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Comments
The patient has huge extruded disc and far
downward migrating. It needs special modified
approach to reach it, other wise it could be
missed.
The estimated recurrence rate, still around 7%
because the disc space still not 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 .
