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
neurosurgery.tv
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16-DECEMBER-2009 ABDEL-AMEER UTHMAN SHAMRAN 57 YEARS
SEVERE CERVICAL CANAL STENOSIS C5-6, C6-7. RESIDUAL AFTER ANTERIOR FUSION C4-5-6
3 YEARS AGO.
Anamnesis:
The patient
was operated by me
28-December-2005
for severe compression of the cervical spine due
to osteomyelitis of C5 with pathological
fracture.
The patient then came to the
clinic 14-November-2009 complaining of LBP
with increased weakness of the left hand and the
right foot with difficulty of walking.
MRI of the lumbar spine performed
15-November-2009 showing PLD L1-2 and the
cervical spine showing the deformed C4-5 but
acceptable, with severe stenosis at C5-6 and
C6-7 levels with malacia of the spinal cord at
these levels. Dynamic studies ruled out presence
of overmobility and solid fusion of C4 and C5.
Decompressive laminectomy of
C5-6-7 was achieved and check for instability
was performed at all stages of the surgery. The
epidural fat was absent at the decompressed
levels and the dura became lax and free after
the decompression. Check image-intensifier was
used all the time.
Routine closure of the wound.
The power of the left hand and right foot
immediately improved after surgery.
Comments
The de novo stenosis could be
the result of 2 elements evolving over the time:
1. Progression of osteoporosis, which led to
compression of the spinal cord from behind, and
2. The stress of the movement of C4-5 was
transferred to the below level, which led to
gradual degeneration of the disc and triggered
the stenosis anteriorly.
Even the fused segment of
C4-5 is ugly in visual inspection, but it is
acceptable from functional estimation and
causing no harm to the patient.
The posterior fusion
instrumentation was ready to be used, but the
absence of instability, made this fusion
meaningless.
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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 .
