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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07-DECEMBER-2011 SAMYAH SALEM ABU-ABOUD 59 YEARS
EXTRUDED HUGE DISC L3-4 WITH DOWNWARD MIGRATION WITH ELEMENTS OF RESTENOSIS OF
L2-3 AND L4-5.
Anamnesis
The
patient was operated by me
05-September-2007 for dorsal and lumbar
canal stenosis after what she was doing OK1
The
patient then came 19-November-2011 complaining
of numbness both lower limbs below the knee the
last 3 months with coldness both feet with
difficult walking.
On
examination, the patient walking bended with aid
of two persons. SLRS was 90 degrees both sides
without pain. There is weak dorsi and
planterflexion both feet -4/5. Sensation was
preserved.
The
patient was sent for new MRI and lab
investigations, which were done 20-November-2011
showing stenosis of L2-3, L3-4 and L4-5
with malacia of the spinal cord behind D10-11
with huge extruded disc L3-4 with downward
migration. Vit D3 was 36.6 nmol/L which low.
Skeletonization of the left
L2-3, 3-4 and L4-5 lateral masses. Drilling of
the medial walls of these facets to gain
decompression. foraminotomy of left L3 and L4
roots. The dura and the roots were so thin, that
practically there was only arachnoid membranes
were seen. The places were the scar was not
separable and attached to what must be
considered dural sheet was left in place. The
extruded disc L3-4 with left downward migration
was removed in several pieces and left sided
cleaning of L3-4 disc space was achieved. There
was CSF leak coming from the area of the removed
extrusion, but there was no tear. A muscle was
harvested to cover the thin dural areas to
prevent postoperative CSF leak.
Routine
closure of the wound with several water-tight
layers. Smooth postoperative
recovery with improvement of the power of
the feet.
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Comments
The patient had 17 years ago surgery for
stenosis of L3-4 and 4 years ago for stenosis of
D10-11, D11-D12, D12-L1 and L4-5.
Restenosis took place at L2-3. L3-4 and L4-5 and
the huge extrusion was the trigger factor of her
complains.
Decompression was applied from the left side, so
as to remove the extrusion and regain
decompression of the restenosed area.
Despite the fact, that the dura was preserved,
but it was practically missing over wide area
without seeing any tear.
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 .
