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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19-JANUARY-2011 SALAH MUHAMED ABU-HAMDEH 68 YEARS LCS
L3-4, L4-5 AND SPONDYLOLISTHESIS L4-5.
patient came to the clinic 22-August-2004
complaining of LBP with left hip pain for 5
years and left sciatica and numbness left L5
territory for 1 month. The patient was limping
with exaggerated scoliotic stance with SLRS 80
degrees both sides and weak dorsi,
planterflexion both feet and quadriceps femoris
both legs 4/5. MRI dorsal and lumbar spine
performed 24-August-2004 showing small extruded
disc D11-12 and spondylolisthesis L4-5 with
bulge disc at this level. The patient was
welling with conservative treatment and he came
18-November-2007 claiming that after TUR got
exacerbation of numbness of the left foot with
dyseasthesia. MRI lumbar spine performed
13-May-2007 showing spondylolisthesis II degree
with secondary stenosis. The patient then came
21-May-2008 with the same clinical picture, but
claiming that he had episodes of improvement and
he could walk more than 1 Km. The patient then
came 17-August-2010 claiming that he got
dramatic deterioration the last 2 weeks,
dragging his both legs and he could not walk
more than 20 meters with bended and scoliotic
stance. The power of the right foot became
weaker than before and the patient was advised
to undergo surgery, but he escaped. The patient
is a known diabetic. The patient then came
10-December-2011 complaining of both buttock
pain with inability to walk more than 50 meters.
The scoliotic stance became more exaggerated
with more weak both feet.
MRI of the
lumbar spine done 29-December-2011 showing
second degree L4-5 spondylolisthesis with
segmental stenosis at L3-4 and L4-5 with old
fracture of D11.
Skeletonization of L3-4-5 and partial of L2 down
to the transverse processii L3, 4 and 5.
Laminectomy L4 and partial of L5 and L3.
Foraminotomy of L4 and L5 roots both sides. The
left L3-4 lateral mass was fractured with
isthmolysis. Both L3-4, and L4-5 were over
mobile. There was no epidural fat at the
operative level. Discectomy L4-5 and L3-4 from
the left side. TILF cage 9 mm inserted to L4-5
level and No 10 to L3-4 level with Novabone and
bone grafts harvested from the spinous
processii. SpineWay Polyaxial reduction screws
6x40 inserted to L4 pedicles. Polyaxial
reduction 7x45 screws inserted to L3 level.
Polyaxial reduction screws 6x45 mm inserted to
L5 level. 2 rods bended to adapt the
natural curve of the area were used with
crossLink multidirection. The area lateral to
the rods was aided with bone grafts.
closure of the wounds. Smooth postoperative
recovery with improvement of the power of both
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The patient have II degree spondylolisthesis
with segmental stenosis L3-4, L4-5. During
surgery it was found that L3-4 was more mobile
than L4-5. It was necessary to resolve the
problem to both levels.
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 .