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
Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator .
19-JULY-2015 SAHAR RAJA AL-HARASIS 37 YEARS
EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 15-July-2015
complaining of LBP with right sciatica for 10
years of intermittent course with exacerbation
the last 10 days with shooting pain down to the
lateral malleolus right leg. MRI lumbar spine
done 21-Ocotbe-2014 showing bulge L3-4 and L4-5.
On examination; The patient is in agonizing
pain, limping with exaggerated scoliotic stance.
SLRS was 70 degrees with pain in the right.
There is weak dorsiflexion right foot 4/5.
The patient was sent for investigations and MRI
of the lumbar spine performed the same day
showing extruded disc l4-5 with right downward
migration,
Using the C-arm, the L4-5 level was identified.
Foraminotomy right L5 root was performed. The
root and the surrounding dura were adherent to
the flavum, that a dural tear was not avoided to
obtain the foraminotomy. The extruded disc was
severely compressing the root. The root with
sharp microdissection was shifted from over the
extrusion. The extruded disc was removed and
right sided intradiscal cleaning L4-5 disc space
was achieved. The dural defect was repaired
using nylon 4 zero. The head of the patient was
brought up and Valsalva maneuver was performed.
No CSF leak. Routine closure
of the wound.
Smooth postoperative recovery. The power of the
right foot became normal. The patient and was
sent to the floor.
Comments
The recurrence rate is around 7% because
the disc space is still not completely shallow.
The patient has long history
of the extrusion, that the structures of the
involved area were adherent and causing thinning
of the dura and dissection was impossible
without having dural defect
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
fixation is the most accurate system in the market. The microdrive and
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Inomed MER system
ISIS 32 channel Inomed IOM system for intraoperative
neurophysiologic navigation running since 2007.
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
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 .
