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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31-MARCH-2008 MRAWEH MUHAMED MUSTAFA 63 YEARS
SEVERE CERVICAL STENOSIS C3-4. 4-5. 5-6 WITH STABLE OSSIFIED OLD DISLOCATION
The patient came to the
clinic 13-March-2008 complaining of neck pain
and ataxia and fainting attacks for 25 years.
Cervical X-ray done 1994 showed dislocated C4-5.
The last 2 months, he had left sided headache.
MRI cervical spine performed
04-March-2008 showed kinking of the spinal cord
at C3-4 with stenosis at this level and C4-5 ,
mainly from posterior elements. MRI of the brain
On examination: Romberg test
was negative. Weak right deltoid and right
biceps brachii and extension both hands
and the right triceps muscle. He had also weak
dorsiflexion both feet and planterflexion right
foot. and right quadriceps muscle. There was no
sensory deficit, nor pathological reflexes.
The patient was sent for
simple X-ray of the cervical spine with
extension and flexion, which confirmed the bony
fusion of C3 and C4 bodies.
The patient is a known
hypertensive with hypoten 50 mg per day and in
Decompressive laminectomy of
C3-4 and 5 was done using the high speed drill. The
epidural fat was absent at these levels.
All compressing elements were eliminated. The
most compressed part at C3-4 was decompressed
last in the right side, to minimize the surgical trauma.
Routine closure of the wound
with smooth postoperative recovery.
Dramatic recovery of the power
of the upper limbs and the
Posterior decompression of
the cervical spine in CCS seems to be more
acceptable than the anterior approaches, using
the new modifications with the high-speed
drilling. By this method surgical trauma
becoming to zero.
In the past, posterior
decompression was associated with lot of
complications due to surgical trauma by using
the Smith-kerrisons and so on instrumentations.
The patient has bony fused
C3 and C4, which could be after some
inflammatory process with old spondylolisthesis
of C3-4. But the disc space is very narrow and
the bodies are fused. The main compressing
elements were arising from the posterior
elements. From anterior approach the patient
mostly will not benefit and the comparative ease
and effectiveness of the posterior approach made
the posterior decompression, the appropriate
solution for his problem.