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
Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator
03-JUNE-2014 MAJIDA DAWOOD AL-KAYYALI 62 YEARS
EXTRUDED DISC L4-5 WITH RIGHT RIGHT FORAMINAL OCCLUSION AND SEGMENTAL STENOSIS
WITH POSSIBLE OVERMOBILITY.
The patient came to the clinic 31-August-2008
complaining of LBP with left sciatica for 1 year
after lifting heavy object with exacerbation
last month. MRI lumbar spine done 03-August-2008
showed dehydration L4-5, L5-S1 with small
extrusion L4-5 left side. SLRS at that time was
70 degrees with pain in the left with weak
dorsiflexion left foot 3/5. The patient is a
known diabetic with arterial hypertension for 4
years. The patient was treated conservatively.
The patient then came 15-January-2009
complaining of exacerbation of LBP with left
sciatica for 3 weeks with agonizing left
sciatica with weak dorsiflexion left foot 2/5,
and planterflexion same foot 3/5. SLRS was 10
degrees with pain in the left. MRI lumbar spine
repeated 16-January-2009 showing extruded disc
L4-5 with left downward migration. It was agreed
with the patient to try conservative treatment
and in case of not improving, then to consider
The patient then came 06-April-2014, telling
that after falling down in the elevator 2 years
ago the left sciatica became right with
exacerbation of the right sciatica the last 20
On examination; The patient is limping without scoliotic stance. SLRS was
degrees in the right with pain. There is weak
dorsiflexion right foot 3/5 and left foot 4/5.
The right AJ was absent. The patient sent for
new investigations, which were done 19-May-2014
showing extruded disc L4-5 with right foraminal
occlusion with severe stenosis at this
level. Dynamic studies were not informative.
Using image-intensifier, the L4-5 level was
identified. Check for instability was negative.
Laminectomy of L4 and upper third of L5 was
done. Flavotomy of L3-4 was done. Foraminotomy
L5 roots both sides. The extruded disc in the
right side was removed and right sided
intradiscal cleaning of L5-S1 was done.
Inspection of the right L5 root revealed that
there is still a mass under the root , which is
compressing the nerve. Trail to reach the lesion
from under the axilla and lateral to the axilla
failed to decompress the compression. The dura
was opened parallel to the incision and the
right L5 root was inspected. The extradural
compression was squeezed out lateral to the
axilla and removed. The root was calcified. The
dura was very thin and many stitches of nylon 6
zero was needed to obtain water-tight closure of
the dura. The dural closed defect was aided with
pieces of muscle. Routine closure of the wound.
Smooth postoperative recovery. The power of
both feet became normal.
The estimated postoperative recurrence is
still around 7%, because the disc space is still not
Think thousand of times before opening
the dura at the compressed level. It is very thin and liable
to additional tears during closure.
It is rare, but have place, that the
patient could have intradural fragments, which if missed,
the patient will suffer for a long time until these
intradural fragments are removed.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
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 .