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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12-NOVEMBER-2012 YUSRA JUMAA NOFEL 47 YEARS
EXTRUDED DISC L5-S1 WITH LEFT UPWARD MIGRATION.
Anamnesis
The patient came to the clinic 09-Aprel-2005
complaining of LBP and left sciatica for 13
years with neck and right upper limb pain for
one year. She underwent left CT release 18
months ago without improvement. MRI lumbar spine
done 06-February-2002 showed extruded disc L5-S1
with left downward migration. On examination at
that time, she had weak grip right hand and
right triceps muscle with neck pain when looking
to the right. SLRS was 50 degrees in the left
with pain with weak planter and dorsiflexion
left foot 4/5. MRI of the neck and lumbar spine
performed 26-May-2007 showed small extruded
disci C5-6, C6-7 and PLD L4-5 and L5-S1. It was
decided to continue conservative treatment.
The patient then came 07-November-2012 with LBP
and left sciatica for 4 months and exacerbation
the last week with agonizing pain and numbness
of the left foot.
On examination: the patient is limping with
exaggerated scoliotic stance. SLRS 20 degrees in
the left
with pain and 50 degrees with pain shooting to
the left leg. There is
weak dorsiflexion both feet 3/5.
MRI lumbar done 10-November-2011
showing huge extruded disc L5-S1 with far left
upward migration. The patient since insured was
hospitalized at Tachasusi hospital and the
radiologic report is missing and she was treated
for neuritis. The patient was transferred to
Shmaisani hospital.
Partial left L5
hemilaminectomy with foraminotomy left S1 root.
The extruded disc L5-S1 was removed lateral to
the axilla. Osteophytectomy was done to
eliminate all sources of compression with
meticulous cleaning of L5-S1 disc space from the
left. Inspection of the left L5 root territory
to rule out remnants of any fragments.
Routine closure of the wounds. Smooth
postoperative recovery. The power of the left
foot
became normal.
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Comments
The patient had several
extrusions of the L5-S1 with changing character.
The last attack was the last straw, which
brought the patient to the operating table.
Since the extrusion had old and new components,
it is natural to remove the fresh and
osteophytic components of the extrusion.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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