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Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. This Site is a Video Gallery
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18-SEPTEMBER-2006 SARIYAH MUHAMED
RASHEED 46 YEARS RECURRENT PLD L4-5 RIGHT SIDE.
Anamnesis
The patient was operated by me
04-August-2002
for PLD L4-5 right side and he made good
recovery, until 10 days ago got agonizing right
sciatica with inability to walk or set down. The
patient was advised to perform repeat MRI lumbar spine, which was
done 17-September-2006 and showed a huge recurrence at the same
level and side.
On examination, he had almost drop right foot
and severe right sciatica with hypalgesia right
L5 root. The patient was advised to undergo
surgery.
Through the same incision, right L5
foraminotomy was performed and the root was followed upward and the
extruded disc was stuck with the root. Lateral to the axilla the
sequestrated disc material was removed and further cleaning of the
disc space was performed from the right side. The patient was put in
Reverse Trendelenburg position with Valsalva
maneuver and hyperventilation. No CSF leak.
Routine closure of the wound.
Smooth postoperative recovery.
The power of the right foot improved.
He was sent to the ward.
Follow Up
The patient came to the clinic 30-Sptember-2006
with clean wound and full power of the right foot
with hypalgesia both L5 and S1 territories as
diabetic neuropathy type.
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Comments
There is still an estimated postoperative
re-recurrence around 7%.
Since the defect in the annulus fibrosis
in the first surgery was wide, the possibility for
recurrence was relatively higher than usual. There is a
possibility that the intradiscal material with time can give
growth and each time when performing meticulous cleaning, a
large quantity of disc material come out, holding the
possibility of such speculation.
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 .