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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23-NOVEMBER-2012 AFIFE ALI MUQBIL 73 YEARS
SEVERE LUMBAR CANAL STENOSIS L2-3, L3-4.
The patient was operated by me
for PLD L4-5 with secondary segmental stenosis.
The patient then came 03-November-2010
complaining of bilateral sciatica with right
upper limb pain and numbness of the right hand
for what later right carpal tunnel release was
done. The patient could walk more than 1 Km and
had no motor deficit. MRI lumbar spine done
06-November-2010 showing stenosis of L2-3 and
L3-4 with slight stenosis of C5-6, C6-7. Gout
was found and conservative treatment was
The patient then came 22-November-2012
complaining of LBP for 4 months with bilateral
sciatica with exacerbation the last month. She
cannot walk more than 20 meters.
MRI of the lumbar spine done 22-November-2012
showing severe lumbar canal stenosis L2-3 and
L3-4. Dorsal MRI was normal.
On examination: the patient is limping
as dragging the left leg with
exaggerated scoliotic stance. SLRS 60 degrees
both sides with pain. There is
weak dorsiflexion both feet 4/5. The quadriceps
femoris are also weak 4/5.
Decompressive laminectomy of L2,3
with foraminotomy L3, L4 roots both sides.
Dissection was done down until the scar was
freely movable. Bilateral flavotomy L1-2. The
dura was lacking the epidural fat due to severe
compression. Check of the roots for any
compression both sides. The bulge disc of L3-4
was contained and it was decided not to violate
Routine closure of the wounds. Smooth
postoperative recovery. The power of both feet
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The patient has
severe lumbar canal stenosis which progressing
over the time and it is hard to predict the
escalation of the events until the stenosis
becoming clinically proven to be corrected by
Bilateral flavotomy of L1-2 was done to prevent
future escalation of the stenosis at this level.
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