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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13-SEPTEMBER-2013 SULAYMAN AHMAD ABDO 57 YEARS HUGE EXTRUDED
DISC L4-5 WITH CAUDA EQUINA SYNDROME.
Anamnesis
The patient was admitted to Emergency Shmaisani
hospital coming from Saudia with a history of
LBP for 1 week with bilateral sciatica. 3 days
ago while walking, he felt due to profound
weakness both legs with micturition problems and
numbness of the perianal region.
MRI lumbar spine done 10-September-2013 showing
huge extruded disc wide based with left upward
migrating sequester, resulting in severe segmental
stenosis.
On examination: the patient in bed, could pass
urine with difficulty, with SLRS 70 degrees
without pain. The AJ is absent both sides. There
is analgesia in the perianal region, extending
down to medio-posterior aspect both thighs.
Using the C-arm, the L4-5 level was indentified.
Partial laminectomy L4 and L5. Foraminotomy L5
root both sides. The extruded left upward
migrating disc was removed in one big piece.
Left sided intradiscal cleaning L4-5 space.
Inspection from the right side, revealed no
extrusion. Routine closure of the wound.
Smooth postoperative
recovery. The power of both feet became normal.
Comments
The patient has stenosis with upward migrating
huge disc, which together caused the cauda
equina syndrome.
SLRS was not dramatic, because the extruded disc
was separated from the annulus fibrosis.
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