Munir Elias 20-12-2013

Dr. Ali Al-Bayyati and Dr. Munir Elias

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24-OCTOBER-2012  UMAR ABDEL-LATIF AL-BASHITI  55 YEARS HUGE EXTRUDED DISC L5-S1 WITH RIGHT UPWARD MIGRATION.

 

Anamnesis

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The patient came to the clinic 22-October-2012 complaining of agonizing LBP with bilateral sciatica for the last 10 days, more during night. He cannot walk more than 100 meters with difficulty and pain. The patient was operated by me for huge extruded disc C4-5, C5-6 06-September-2012 through anterior approach. The patient improved from his quadriplegia. The patient then came with clinical deterioration 21-March-2011 with difficult walking the last 2 weeks  and investigations confirmed the presence of cervical stenosis, for what, he was operated 26-March-2011 by decompressive laminectomy C4-5-6 and partial of C7. The patient then got improvement with good power of four limbs but with persistent sensory deficit of the lateral aspect of the right upper limb and below the left Th10. The patient then came 23-May-2012 complaining of general weakness and heaviness in walk with LBP. MRI of the cervical spine was uneventful, and the MRI of the lumbar spine 27-May-2012 showed bulges of L3-4, L4-5 and L5-S1. The patient was treated conservatively and the power of the four limbs were at that time 5/5.

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On examination: the patient was limping with scoliotic stance. SLRS was 30 degrees with pain both sides. There is almost drop right foot with weak planterflexion right foot -3/5 and dorsiflexion left foot -4/5 and planterflexion left foot 4/5. There is analgesia of the left L5 root. Both quadriceps are weak 4/5.

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The patient was sent for whole spine investigation and done 23-October-2012 showing huge extruded disc L5-S1 with right upward migration.

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Right L5 partial hemilaminectomy with preservation of ligamentum flavum, which was reflected to the left. The huge extrusion was removed lateral to the axilla in several big pieces. The L5-S1 disc space was shallow any empty from any disc material.

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Routine closure of the wound. Smooth postoperative recovery with normalization of the power of the left foot and improvement of the power of the right foot.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient has an estimated postoperative recurrence below 7%, because the disc space is shallow and empty.

 

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