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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ZAHRA JABER ABU-AZZAM 66 YEARS SEVERE STENOSIS L4-5 WITH
OLD EXTRUDED DISC L5-S1 WITH RIGHT FORAMINAL OCCLUSION.
The patient came
to the clinic 26-July-2004 complaining of LBP
with bilateral sciatica more to the right with
numbness of both feet and inability to walk more
than 100 meters. The patient is hypertensive for
2 months without medication.
MRI lumbar spine done 22-July-2004 showing
severe stenosis L4-5 with I degree
spondylolisthesis and extruded disc L5-S1 with
On examination: The patient is limping
with exaggerated scoliotic stance. SLRS was 90
degrees in both sides. There is
weak dorsiflexion both feet -4/5.
Decompressive laminectomy L4
and L5 with foraminotomy both L5 and both S1
roots was done. The extruded disc of L5-S1 was
inspected and not removed because it was hard,
immobile. The right S1 root was decompressed of
all surrounding elements. Check for
instability was negative. The subcutaneous fat
was harvested with pedicle and transferred to
the dura to decrease the postoperative scar
Routine closure of the wound.
Smooth postoperative recovery. The power of
both feet became normal.
The old degenerative extruded disc of L5-S1 was
left untouched because there was no necessity to
The spondylolisthesis of L4-5 is still difficult
to estimate its role in the clinical setup. Time
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