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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27-MARCH-2013 NAWAL ISMAEEL TAYA 35 YEARS
EXTRUDED DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
The patient came
to the clinic 23-March-2013 complaining of LBP
for 3 years with left sciatica for 1 month with
exacerbation last week. The pain shooting down
to all toes left foot more to the big toe.
MRI lumbar spine done 20-March-2013 bad quality showing
small extruded disc L4-5 left side.
On examination: The patient is in agonizing
pain, unable to walk or stand to evaluate for limping
or scoliotic stance. SLRS was 40
degrees in the right with pain and 3 degrees in the left
with more pain shooting to the right. There is
weak dorsiflexion left foot 4/5 with hypalgesia
left L5 and S1 roots.
The patient was sent for further investigations,
which confirmed the presence of huge extrusion
L4-5 with left foraminal occlusion with left
downward migration with normal pelvic anatomy
except for polycystic both ovaries.
Using C-arm, the level of
L4-5 was identified, because the patient was
fatty. Left partial L4-5 flavotomy and foraminotomy
left L5 root
was done. The
extruded extrusion was
removed lateral to the axilla in one piece. Left sided
intradiscal cleaning L4-5 disc space.
Routine closure of the wound.
Smooth postoperative recovery. The power of
the left foot became normal.
There is still an estimated postoperative
recurrence around 7%, because the disc space is
still not shallow.
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