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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26-SEPTEMBER-2009 MANAL IBRAHEEM BAKEER 40 YEARS
EXTRUDED DISC L5-S1 WITH FAILED INTRASPINOUS FIXATING DEVICE.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
The patient came to the
clinic 25-August-2009 complaining of LBP for 10
years with bilateral sciatica. MRI lumbar spine
performed 21-February-2008 showing extruded disc
L5-S1. The patient was operated elsewhere and
intraspinous fixating device was inserted
without any improvement. MRI repeated
20-April-2009 showing the same extrusion and
added compression from behind by the fixating
The patient was limping and
walking with aid and exaggerated scoliotic
stance with shooting bilateral sciatica. SLRS
was 70 degrees in both sides with pain. The
patient had weak dorsiflexion both feet and
planterflexion left foot 3/5 and planterflexion
right foot 4/5. There is numbness both feet.
New MRI and dynamic studies
of the lumbar spine were performed and done
07-September-2009 showing the device and the
extruded disc of L5-S1 compressing both the
dural sac from both sides.
The lower half of the
incision was refreshed and the flail
intraspinous fixating device was removed. There
was no trade mark in the device and only 7 mm
was found as the device measurement. Left
hemiflavotomy was performed and the left S1 root
was exposed. Meticulous cleaning of the extruded
disc and the intradiscal space of L5-S1 was
achieved. The left S1 root became free from any
Routine closure of the
wound and smooth
and the patient sent to
This case is a demonstration
that all the devices starting with Nelson
spinous fixating devices all finish with failure
since 1980. The spinous processii are not so
heavy bone constructs, that can hold the spine,
not mentioning that it is far from the central
axis of load.
The patient had only extruded
disc which required its removal and there was no
instability to perform such erroneous
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 .