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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20-DECEMBER-2013 MAHMOUD MUHAMED ABDEL-QADER 54
YEARS EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
The patient came to the clinic 19-December-2013
complaining of LBP for 3 weeks with right
sciatica. Exacerbation of the LBP with right
sciatica with numbness of all the
toes right foot.
MRI lumbar spine done 09-December-2013 showing
extruded disc L5-S1 with right downward
On examination is limping, in agonizing pain with exaggerated
scoliotic stance. SLRS was 60
degrees right side with pain. There is
weak dorsiflexion right foot 3/5 and planterflexion right foot -4/5.
There is hypalgesia right L5, S1 root
territories. The right AJ is absent.
Using C-arm, the L5-S1 level
was identified. Using DePuy Spine Spotlight
microdiscectomy tubular retractor system 24 mm, Foraminotomy right S1 root was
achieved. The extruded disc was removed
subaxillary in 2 big pieces and right sided
cleaning of L5-S1 disc space was performed. During the procedure, several
endoscopic maneuvers were applied to trade for
good illumination and good video recording by
the use of Leica HM500 microscope, but
video recording most of the time failed during
recovery. The power of the right foot became
normal and the agonizing right sciatica
The estimated postoperative recurrence of L5-S1
is still around 7%, because the disc space is
still not completely shallow.
Combination of Leica microscope with Depuy spine
Spotlight system, still unable to give the ideal
In the first case done 05-December-2013, the
incision was midline as in this case, but sharp
dissection of the bone was done before inserting
the tubular system. This was done in first case
to minimize the trauma to the muscles during
splitting. In this case the introducers and
tubular system were introduced directly without
skeletonization of the bone. This caused more
trauma to the muscle and misdirection of the
tubular system. From these 2 scenarios, it is
preferable to do we did in the first surgery.
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Notice: Not all operative activities
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