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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11-AUGUST-2008 MUHAMED KHALEEL AL-MUAALEM 73 YEARS
SEVERE CERVICAL CANAL STENOSIS MORE AT C4-5 WITH MYELOPATHIC SYNDROME.
The patient came to the
clinic 30-July-2008 complaining of walking
difficulty for three years. Deterioration the
last 10 months in wheelchair.
MRI done 20-July-2005 showed
PCD C4-5 with OPLL C5-6 and C6-7.
On examination: the patient
unable to stand to evaluate the scoliotic
stance, the tongue protruding to the left.
Hoffmann positive both sides with hypalgesia
starting from the left V2 division down to
include the left upper and lower limbs. Flexion
both hands 4/5, extension both hands 3/5, both
biceps brachii 4/5 and deltoids 4/5, the right
triceps 2/5 and the left 4/5. All muscles lower
limbs were weak 4/5. Babinski was positive in
the right with more spastic pattern of the right
lower limb and bilateral clonus.
The patient was sent for MRI
of the brain and the cervical spine, which ruled
out the presence of brain stem infarctions and
the presence of severe malacia of the spinal
cord at C4-5 level with severe compression of
the cervical spine at this level with lesser
degree at C5-6.
Discectomy of C4-5 with
meticulous cleaning of all osteophytes and disc
material compressing the spinal cord, until the
dura was free from the far left to the far right
side. Decompressive discectomy of C5-6.
Using miniplate 2 levels with 6 screws, fusion
of C4-5-6 was done. Using the milling machine of
Midas Rex the bone harvested during surgery was
milled and applied to the empty spaces.
Routine closure of the wound
and smooth postoperative recovery with
improvement of the power of four limbs.
The patient had severe
compression of spinal cord at C4-5 level with
malacia of the spinal cord. After decompression
the neurological status improves, but this
result must not be promised to the patient
before surgery, because the main aim of surgery
is to stop the process of deterioration.
The disc space of C6-7 was
very shallow with actual fusion of both bodies,
for what it was not included in the fusion
process, taking into consideration, the age of
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Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .