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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21-SEPTEMBER-2008 MUHAMED IBRAHEEM HASAN 67 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION AND COMPLETE FORAMINAL
OBLITERATION.
Anamnesis:
The patient started to
complain of LBP with
left sciatica for eight months. The last three
weeks got exacerbation of the LBP and left
sciatica with numbness all toes left foot.
MRI performed
11-September-2008 showed extruded disc of
L4-5 with left downward migration and complete
occlusion of the left foramen.
On examination: the patient
in agonizing pain. The patient had hypalgesia of
left L5 territory. He had almost drop left foot and
weak planterflexion left foot 4/5.
Left hemiflavotomy of L4-5
was done and foraminotomy of left L5 root was
achieved. The extruded with down migrating
piece was removed in several fragments.
Considering that the disc space still high and
the annulus fibrosis is not hard and there is
defect under the annulus, it was decided to
clean the L4-5 disc space meticulously from the
left side.
Coagulation around the defect
of the annulus fibrosis to shrink the diameters
of the defect.
Routine closure of the wound
and smooth postoperative recovery.
Comments
The patient had complete
obliteration of the left L4-5 foramen with
severe compression of the left L5 root. This
must be resolved by surgery.
The estimated recurrence in
this case is around the average -7%, because the
disc height is not shallow. Coagulation of the
defect of the annulus fibrosis decrease
the dimensions of the defect, which
theoretically could lead to lower the estimated
postoperative recurrence.
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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 .
