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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18-MARCH-2008 BASHAR AHMAD JABER 32 YEARS EXTRUDED
DISC c3-4 WITH CENTRAL SPINAL CORD COMPRESSION.
The patient came to the
clinic 16-February-2008 complaining of neck pain
right side. He had residual after RTA 1987 with
traction injury of the right C7 root, which was
compensated with mild to moderate atrophy of the
muscles of the right hand and hypalgesia of the
MRI done 14-February-2008
showing PCD C3-4, central more to the left and
pseudocele right C7 root.
On examination: the power of
both deltoids and biceps brachii and triceps are
5/5 with the mentioned previous deficit, which
is related to the previous accident.
The patient was advised to
undergo conservative treatment with collar.
The patient was admitted
elsewhere and traction was applied to him, after
what exacerbation of the pain and deterioration
of his condition took place. He came to the
clinic 12-March-2008 with agonizing pain and
weak right deltoid and biceps brachii.
MRI cervical spine done
15-March-2008 showed enlargement of the
extrusion and malacia of the spinal cord.
Under image-intensifier the
C3-4 level was identified and anterior
discectomy of C3-4 was performed. All the old
and recent compressing elements were removed.
Routine closure of the wound
with smooth postoperative recovery.
The pain in both shoulders
and the power of the proximal muscles of the
right upper limb returned to normal.
The first visit was planned
to undergo conservative treatment, with the hope
that the extrusion could shrink by time.
When extrusion is compressing
the spinal cord, it is not wise to perform
traction, since this could lead to catastrophic
and sometimes irreversible events.
The longus colli muscles
where very medially located at the C3-4 level,
that it was impossible to detect them by the
usual dissection methods. It was necessary to
use the image-intensifier to find not only the
level in lateral view, but also the AP view to
identify the midline.