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
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
17-JULY-2014 SAMIR RASHEED ABU-AL-AYNAIN 55 YEARS
EXTRUDED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.
Anamnesis
The patient came to the clinic 08-December-2012
complaining of LBP with left sciatica for 10
days with with numbness down to the big toe left
foot with intermittent LBP for 8 years. The
patient underwent cath 2007 and stinting was
applied.
The patient at that time was limping with mild
scoliotic stance. SLRS was 30 degrees in the
left with pain and 60 degrees right side with
less pain. There was weak dorsiflexion left foot
3/5. The patient was sent for investigations and
MRI lumbar spine done 11-December-2012 showed
extruded disc L4-5 with left downward migration.
he patient was advised to undergo surgery but he
was reluctant and disappeared.
The patient then came 14-July-2014 with
agonizing LBP and right sciatica for 2 months.
The patient is unable to set in a chair. MRI
lumbar spine bad quality open type was done
09-July-2014 showing as be having an extruded
disc of L5-S1 with right downward migration. He
underwent cath 2011 and the cath results were
acceptable.
On examination; the patient in agonizing pain, was limping with
exaggerated scoliotic stance. Positive cough
sign, SLRS was 40 degrees with pain in the right
and 70 degrees without pain in the left. Weak
dorsi and planterflexion right foot -4/5.
The patient was sent for investigations and the
MRI lumbar spine performed the same day, showing
the extruded disc of L5-S1 with right far
downward migration. The old extruded disc of
L4-5 in the left side suffered shrinking.
Dynamic studies were normal.
Right S1
foraminotomy with preservation and reflection of
ligamentum flavum to the right was done. The
extruded disc was removed lateral to the axilla.
Right sided intradiscal cleaning of L5-S1 disc
space. Routine closure of the wound.
Smooth postoperative recovery.
The power of the right foot became normal.
Comments
The estimated postoperative recurrence is
still around 7% because the disc space height is still not
shallow.
Preservation of the ligamentum flavum is
the best way to decrease the scar formation after disc
surgery. Efforts are paid to preserve the epidural fat
during surgery
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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 .
