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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28-NOVEMBER-2013 NASHMIYEH ABED DAHY 65 YEARS
HUGE EXTRUDED DISC L4-5 MORE TO THE LEFT WITH TOTAL SEGMENTAL STENOSIS.
The patient came to the clinic 24-November-2013
complaining of LBP for 10 years with left
sciatica for 1 year down to left L5 territory.
She is a known hypertensive for 8 years. The
patient receiving Plavix 75 mg daily and it was
stopped the day before coming to the clinic.
MRI lumbar spine done 07-February-2013 showing
extruded disc L4-5 right side with complete
On examination is limping, in agonizing pain with exaggerated
scoliotic stance. There is pain in the neck when
turning the head to the right with weak grip,
extension right hand and the right triceps muscle
4/5. SLRS was 10
degrees left side with pain. There is weak
dorsiflexion left foot 2/5 and right foot 4/5
and weak planterflexion left foot 3/5. There is
analgesia left L5 root and hypalgesia left S1
The patient was sent for new investigations, and
MRI 24-November-2013 showing huge extruded disc L4-5
left side with total stenosis at this level. There
are small extrusions of the cervical spine at
C3-4, C4-5 and C5-6 levels.
Decompressive laminectomy L4
and L5. The dura was very thin and adherent to
the ligamentous structures, that after their
delicate removal, dural tear was seen at the
right lower part of the field. Using 4 zero
nylon, the defects were repaired, but it seems
that with Valsalva maneuver, a very little
amount of CSF is coming from the points of
needle insertion. Foraminotomy both L5 roots.
The L4-5 extruded disc was seen at the left side
making the left L5 root as its capsule. To
prevent surgical injury to the root, an
intradiscal decompression of L4-5 was achieved
from the left. After that the huge extrusion
started to be extracted out. After removal of
the extrusion and left sided intradiscal
cleaning of L4-5 disc space, the left L5 root
was severely damaged by the extrusion. It
regained lax position and acceptable appearance.
A piece of muscle was added to the repaired
dural defect. Water-tight closure of the wound.
recovery. The power of the right foot became
normal and dramatic improvement of the power of
the left foot.
The patient still has an estimated postoperative
recurrence around 7%, because the disc height is
still not completely shallow.
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