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-DECEMBER-2012 SALEH KARAM HANNA 51 YEARS
SECOND RECURRENCE OF L4-5 WITH RIGHT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 05-December-2012
complaining of right sciatica for 3 weeks with
agonizing LBP. The patient was operated for PLD
L4-5 1975 and 2010.
On examination: the patient
is limping with exaggerated scoliotic stance.
SLRS was 50 degrees with pain in the right and
80 degrees with pain shooting to the right leg.
There is weak dorsiflexion right foot 4/5 with
hypalgesia right L5 root territory.
MRI of the lumbar spine done
24-November-2012 showing huge recurrence of L4-5
with right downward migration with still not
shallow disc space.
The old scar refreshed and
the extruded disc L4-5 was removed in several
pieces, until the right L5 root became lax and
free. Discectomy of L4-5 from the right with
insertion of TLIF TraXis PEEK-OPTIMA®
11x9x21 mm with NovaBone Putty, aided with his
harvested bone before insertion and after
insertion. Using Zimmer Java Instinct polyaxial
screws 6.5x45 mm to the L5 and monoaxial 6.5x40
mm to L4 bodies, transpedicular screw fixation
with slight compression and connector 60 mm
length was applied. Bone graft was added lateral
to the rods.
Routine closure of the wound.
Smooth postoperative recovery. The power of the
right foot became normal and the right sciatica
disappeared.
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Comments
The patient
had second recurrence of the disc and the disc
space is still not shallow. It means that if to
perform simple discectomy, then the recurrence
for the third time still ranking above 7%.
To avoid further recurrence, fusion with TLIF
and transpedicular fixation will eliminate this
recurrence.
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