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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16-APRIL-2012 MAJED MUHAMED AL-DMOUR
58 YEARS EXTRUDED DISC L4-5 WITH LEFT UPWARD MIGRATION.
patient came to the clinic 09-April-2012
complaining of LBP for 10 years with left
sciatica down to the lateral malleolus with
numbness of the left L5 territory for 10 days.
The patient is a known hypertensive for 10
MRI lumbar spine performed 06-January-2009
showing bulge L4-5 and L5-S1 disci.
examination, the patient is limping with
exaggerated scoliotic stance with SLRS 80
degrees with pain in the left side. There is
weak dorsi and planterflexion left foot 3/5.
The left KJ is absent and the right AJ also.
patient was sent for new MRI lumbar spine and
performed 09-April-2012 showing left huge upward
migrating disc L4-5.
Left L5 foraminotomy with far
superior exposure of the axilla and about 10 mm
above it. The posterior longitudinal ligament
was incised to expose the far upward migrating
piece, which was removed in one piece. Left
sided cleaning of L4-5 disc space. The operation
was performed with image-intensifier to minimize
the wound length and dissection.
closure of the wound. Smooth postoperative
recovery. The power of the left foot
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The patient still have an
estimated recurrence rate around 7% because the
disc space height is still not shallow.
The SLRS was 80 degrees despite the presence of
huge extrusion. This is a sign that the
extrusion was completely separated from the disc
space material. If the extrusion was in
continuity, then the patient could have more
agonizing pain with SLRS around 20-30 degrees.
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 .