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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17-APRIL-2010 ELENA NICOLAY ZIKOVA 48
YEARS PCD C5-6 CENTRAL AND C6-7 WITH RIGHT FORAMINAL
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Postoperative Check up showing good alignment of the lower device and shift to
the left of the upper device.
to the clinic 02-February-2010 complaining of
neck and right upper limb pain for 1 year. The
condition is progressing and she progressed
numbness all fingers right hand.
performed 19-December-2009 showed PCD C5-6
central and C6-7 more to the right.
On examination: the
patient has weak grip and extension right hand
4/5 with right triceps muscle 3/5. There is
limitation and pain when looking to the right and
down and swaying the head to the left.
The patient progressed
further deterioration and was advised to
repeat MRI of the cervical spine, which was done
14-April-2010 showing complete occlusion of the
right C6-7 foramen.
discectomy of both C5-6, C6-7 was performed with
removal of the extrusion in the right C6-7 foramen.
Prestige LP cervical system Medtronic was inserted
to both levels 5X16 mm dimension for C5-6 and 6X16
mm for C6-7 disc space. Check
image-intensifier was repeated at all stages of the
surgery and implants insertion.
Routine closure of the wound.
full recovery of the
power of the right upper limb.
The patient was essentially
operated for the extruded disc C6-7 with
complete occlusion of the right foramen.
The extruded central disc
C5-6 was causing stenosis to the spinal cord.
Taking the advantage of surgical intervention in
the same area this stenosis was resolved
surgically to prevent future escalation of the
The best option is to keep
the maximum dynamico-physiological functions of
the violated levels. This can be achieved
nowadays by applying the cervical disc system
such as Prestige LP Medtronic, even for 2
Applying these rules, the
late postoperative stenosis or disc
extrusion of the above and down levels will be
lowered considerably, by minimizing the stress
which will be transferred to these mentioned
It was noticed, that during
insertion of the lower device, the previously
inserted device at C5-6 slipped for 2 mm, for
what it was impacted another time. After that
the lower device slipped for 1 mm and it was
reimpacted accordingly. This fact draw our
alertness about possible slipping of the
constructs. So as, to minimize this possibility,
it will be recommended to keep the patient in
collar for at least 3 months and to avoid
So as to have perfect midline
alignment of the device special instrumentation
must be added to know that the device will be in
absolute precision in the midline, before
proceeding with the other steps of the
operation. Anatomical markers are not sufficient
and image-intensifier can be misleading.
New Brands of this construct
must be added with slight curvature in the AP
plane so as to have more perfect alignment of
the upper and lower bodies (notice that the
upper system is stuck with bone at C6, but
it is for 1 mm protruding at the lower edge of
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 .