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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08-AUGUST-2009 RUQAYA ALI AL-DBEYH 40 YEARS
CENTRAL EXTRUDED DISC L4-5 WITH RIGHT SCIATICA.
Anamnesis:
The patient came to the
clinic 09-April-2008 complaining LBP for 12
years with right sciatica for 6 years
The patient underwent unknown
procedure in Ukraine 1 month ago without
improvement.
MRI of the lumbar spine
performed 09-April-2008 showing central
extrusion of L4-5 and dehydration of L3-4 and
L5-S1.
On examination SLRS was
60 degrees with
scoliotic stance and
weak dorsiflexion both
feet 4/5.
The patient was advised
to keep in conservative
treatment and in case of
not improving, then
consider surgery.
The patient then came
05-August-2009 claiming
that the LBP and
sciatica increased and
she is still scoliotic
with weak dorsiflexion
both feet 4/5 and
planterflexion right
foot 4/5. There is
hypalgesia of the right
L5 and S1 territories.
The patient was sent for
another MRI, which
confirmed increase of
the extrusion of L4-5.
The ligamentum flavum of
L4-5 was reflected to
the left and
foraminotomy of right L5
root was performed.
Removal of the extrusion
of L4-5 was achieved
lateral to the axilla.
Meticulous cleaning of
the disc space was
performed. Using the
Satellite PEEK nucleus
replacement sphere the
trial was reached with
No 10 and the sphere No
11 was inserted with
check under
image-intensifier. The
ligamentum flavum was
reflect to its original
place and routine
closure of the wound.
Smooth postoperative recovery
with improvement of the power of both feet..
Comments
The patient is young and to
decrease the rate of postoperative recurrence
PEEK nucleus replacement was preferable to
decrease this rate.
The height of the disc was
shallow, for what the smallest size of the
spheres was sufficient to increase the disc
height.
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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 .
