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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16-FEBRUARY-2009 MARWAN ALI BANAT 55 YEARS
SEVERE LUMBAR CANAL STENOSIS WITH OLD POLIO LEFT LOWER LIMB.
The patient came to the
clinic 05-May-2008 complaining of right hip pain
with right sciatica and numbness of the toes of
the right foot for one year. The patient has
polio since childhood, with severe paralysis of
the proximal muscles left lower limb.
MRI lumbar spine performed
13-April-2008 showed lumbar canal stenosis L3-4
On examination: the patient
has difficult walking with scoliotic stance with
power right quadriceps 3/5 and left 0/5.
Abduction of the knees right 2/5 and left 0/5.
Adduction of the knees right 2/5 and left 0/5.
SLRS was 5 degrees with pain in the right and
zero in the left due to polio. Babinski was
positive both sides. The left foot was in flexor
deformity with weak both feet 3/5 in
planter and dorsiflexion.
MRI of the brain, dorsal and
lumbar spine done
31-May-2008 showed only the stenosis of the
above mentioned levels. The patient was advised
to undergo surgery, but he escaped.
The patient then came
15-February-2009 with deterioration the last
month with new MRI of the lumbar spine performed
12-February-2009 showing the same stenosis with
the same clinical picture.
Decompressive laminectomy of
L4 and partial of L3 and L5 was performed.
Foraminotomy of both L4 and L5 roots was
achieved. The epidural fat was absent at the
compressed levels and the ligamentum flavum was
adherent to the dura at L4-5 level, for what
sharp dissection was used to avoid tear of the
Smooth postoperative recovery
with normalization of the power of both feet..
Lumbar canal stenosis is a
progressive disease and surgical intervention is
better to be performed as soon as possible,
especially when the patient has polio in one
For many years in the usual
practice, drilling of the bony compressing
elements before reaching the ligamentum flavum
is very advantageous, since it bring surgical
trauma to zero.
Please! wait for 3-5 min till the
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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 .