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-MAY-2013 AMEEN AYMAN MAHAMEED 23 YEARS
RESIDUAL OF GUN SHOOT TO THE L5 BODY 8 MONTHS AGO WITH SUBSEQUENT INFECTION AND
The patient is a Syrian citizen suffered gun
shoot in Deraa Ocotber-2013, after what he was
paralyzed below D10 and had severe destruction
of L5 with longitudinal fracture of the sacrum
with bullet anterior to the sacrum from the
right side. He was operated urgently for
internal bleeding 2 times within the first 3
days and then the bullet was removed with
laparoscopic facility after one month. The
patient was treated several months for severe
infection and osteomyelitis.
On examination: The patient can walk with
crutches, has anaesthesia at both L5, S1 roots
and around the anal region. There is dripping of
urine but can control defecation. Weak
dorsiflexion right foot -3/5, +3/5 left foot.
Weak planterflexion right foot -3/5, +3/5 left
The patient was sent for new MRI lumbar spine,
which done 22-May-2013 showing
resorption of 2/3 of L5 body with massive scar
at L4, 5 and S1 area. ESR was 3 mm/h, CRP was
Decompressive laminectomy L4,
L5 with foraminotomy L5, S1 roots both sides
with neurolysis of the massive scars. Using
Isobar TTL module in, transpedicular fixation
L4, L5, S1 was done. 6.2x40 mm monoaxial screws
were used for L4, L5 bodies. 6.2x45 polyaxial
screws were used for S1 level. 2 rods 5.5x60 mm
bended to adopt the curve of the local area with
Easys cross connector. Vitoss bone graft was
aided lateral to the rods. All stages of surgery
were done with C-arm control.
Routine closure of the wound.
Smooth postoperative recovery. The patient
power and sensation both feet improved.
The patient has an acceptable alignment of L5
body, for what fusion must be achieved. During
this neurolysis is a welcome step.
TLIF cage was not used, to avoid future
escalation of infection.
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Notice: Not all operative activities
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