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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27-DECEMBER-2011 LATIFEH SHAKER JARRAR 75 YEARS
SEVERE CERVICAL STENOSIS C3-4 WITH MALACIA OF THE SPINAL CORD.
patient was operated by me
01-May-2008 for PLD L4-5 with
segmental stenosis, after what she improved, but
she came then 03-October-2010 complaining of LBP
with left sciatica. MRI lumbar spine was
performed 09-October-2010 showing a ganglion at
L4-5 left facet. The patient was advised to keep
in conservative treatment. The patient was doing
well until she felt down in October-2011 after
what she got difficult walking with ataxic gait
with exacerbation of left sciatica. The patient
came to the clinic 19-November-2011.
examination, the patient is limping with
exaggerated scoliotic stance. There is weak grip
and extension of the left hand 4/5 with left
triceps muscle 3/5. Hoffmann was positive in
both sides with DTR more brisk in the left side.
The left quadriceps femoris was -4/5 with SLRS
45 degrees in the right without pain, but 50
degrees with pain in the left. There was clonus
in the left foot.
patient was sent for MRI of the cervical and
lumbar spine, which were done 26-December-2011
showing severe cervical canal stenosis C3-4 with
malacia of the spinal cord at this level. The
L4-5 ganglion still the same size.
Decompressive laminectomy of
C3-4 and C5. There was no epidural fat at these
levels. The laminectomy was extended to abut the
lateral masses, without violating them.
closure of the wounds. Smooth postoperative
recovery with improvement of the power of the
involved weak muscles.
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The patient had ganglion of the left L4-5 facet
compressing the L5 root, but she was in good
condition before the trauma in October-2011, for
what its role was omitted. The cause of ataxia
and left sided weakness with pathologic reflexes
was the severe spinal cord compression with
subsequent myelopathic syndrome.
In case of negligence and performing the surgery
at the lumbar area, the patient with such
cervical spine involvement could result in
Special attention was paid to the neck during
rotation of the patient to the prone position.
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 .