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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04-MARCH-2008 DR. ZUHEYR MUHAMED TAYEF 67 YEARS
SEVERE CERVICAL STENOSIS C3-4 WITH MALACIA OF THE SPINAL CORD DUE TO POSTERIOR
The patient came to the
clinic 01-March-2008 complaining of limping for
three months due to weak left lower limb
associated with numbness both lower limbs. 10
days later got weak upper limbs with numbness
more the left upper limb with mass reflexes of
the left lower limb.
cervical spine done 17-February-2008 showing
severe stenosis of the cervical spinal canal at
C3-4 with the main compressive elements from the
calcified hypertrophied ligamentum flavum with
small bulge of C3-4 disc and malacia of the
spinal cord at that level. MRI of the lumbar
spine showed also LCS at L4-5.
On examination: the patient
is dragging his left leg and has scoliotic stance.
He has rheumatoid-like hands. The power of the
deltoids 4/5 right and 4-/5 left, the
biceps 4/5 both sides. The grip of both hands
5/5, but extensors of the hands 4/5. The triceps
right 4+/5 and 4-/5 left side. There is
hypalgesia of the median distribution of the
right hand. Hoffmann sign is positive in the
left with exaggerated deep reflexes both upper
limbs more in the left. SLRS was
degrees in both sides. The
patient had weak dorsiflexion
4/5 and weak dorsiflexion right foot 3/5 and
planterflexion same foot 4/5, and hypalgesia right L4-4-S1 territories.
The patient was sent for
MRI of the brain with contrast and MRA with MRV
of the brain. The performed
investigations ruled out the presence of other
causes of his problem.
Laminectomy of C3-4 with
partial of C2 and C5 was done, using the
high-speed drill, so as not to violate the
intralaminar structures by Smith-Kerrison or
other devices. The bony cracks and the ligamenta
flava were removed form the dura, which became
relax, even before this moment.
Special attention was given
to the right junction of C3-4, which was drilled
lateral up to the lateral mass.
Routine closure of the wound
and smooth postoperative recovery with
normalization of the power of four limbs and
recovery of sensation?.
So as to avoid surgical
trauma during decompressive laminectomy in
cervical canal stenosis, using the high-speed
drill with thinning of the bony structures,
until they become paper-like thin and crack by
themselves to regain relaxation and
disappearance of compression. By doing that
mechanical trauma becoming to zero. Special
attention must be paid for constant irrigation,
to avoid thermal injury.