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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25-MAY-2010 HELMY MAHMOUD SUWAYES 65 YEARS
LUMBAR CANAL STENOSIS L3-4.
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to the clinic 20-May-2010 complaining of LBP
with inability to bend the spine for 2 months.
The last 3 weeks he became unable to walk with
bilateral sciatica more the left.
SLRS was 75 degrees in the right and 50 degrees
in the left with pain. The patient cannot stand
for evaluation for Romberg or scoliotic stance
evaluation. He has severe profound weak
planterflexion both feet 3/5 and dorsiflexion
right foot 3/5 and left foot 2/5. He had
hypalgesia right L4 root territory.
MRI lumbar spine performed 23-May-2010 showing
severe stenosis L3-4 with bulging L3-4.
Decompressive laminectomy L3 and partial of L4
was performed using image-intensifier, so as to
minimize the area of dissection. All the
compressive elements were eliminated and
inspection of the annulus fibrosis both sides
revealed that it is better not to violate the
disc space of L3-4. Check for instability was
negative. Foraminotomy was done with limited
extension due to abnormal very medial position
of the isthmi.
Routine closure of
Smooth postoperative recovery with
improvement of the power of both feet.
The stenosis was so severe
that, almost drop both feet took place. The
bulging disc was part of his problem, but not
essential. The major problem was from the
hypertrophied facet joints.
Lumbar canal stenosis is
usually a progressive disease and the sooner
surgery is performed the better the outcome.
Discectomy can only be
decided after inspection of the annulus fibrosis
both sides. If it is glistening and there is no
extrusion, it is better not to violated the disc
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 .