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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21-OCTOBER-2008 HANI HASAN AL-LIDAWI 65 YEARS
LUMBAR CANAL STENOSIS L4-5 WITH SPONDYLOLISTHESIS.
The patient came to the
clinic 21-August-2008 complaining of bilateral
sciatica for one year more the left side. He
could walk less than 500 meters with
LSS X-ray performed
12-August-2008 showing spondylolisthesis L4-5.
On examination: the patient
is limping with exaggerated scoliotic stance and
she had weak
dorsiflexion and planterflexion both feet 4/5 with SLRS
was 80 degrees in both sides. He had also
severe OA. both knees.
The patient was sent for MRI
lumbar spine and dynamic studies, which were
done 26-August-2008 confirming the presence of
severe lumbar canal stenosis L4-5 with
instability of the spondylolisthesis at that
Decompressive laminectomy of
L4 and partial of the upper of L5 was performed. The hypertrophied
ligamentum flavum was removed and foraminotomy
of both L5 roots was achieved. Inspection of the
annulus fibrosis of the L4-5 disc confirmed no
extrusion and it was left untouched.
Using USS2 system of
transpedicular screws, fixation of L4 with L5
was achieved. The length of the screws were 45
mm. All the time the procedure was performed
under image-intensifier control.
Tightening of the rods was performed after
slight distraction for 5 mm. The harvested bone
was milled by Midas-Rex mil and fulfilled the
space lateral to the rods.
Routine closure of the wound.
The power of both feet normalized immediately
The patient has severe lumbar
canal stenosis. Decompression alone mostly will
improve the power of both feet, but fixation
will decrease the pain in the long run.
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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 .