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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14-APRIL-2015 AMIRA HASAN AL-ZOOBI 69
YEARS SEVERE CERVICAL STENOSIS C3-4 WITH SPONDYLOLISTHESIS AND MALACIA OF
THE SPINAL CORD.
The patient was operated by me
09-May-2001 for huge extrusion L3-4 with
left downward migration. The patient then was
operated by me 18-August-2003 for huge extruded
disc C4-5 severely compressing the spinal cord.
The patient is a known diabetic with rheumatoid
manifestations and has gout under treatment. The
patient then came 06-November-2013 with left
knee pain and partial tear of the ACL was
established. The patient then came
14-February-2015 telling that she was admitted
to Islamic hospital in Amman with weak left
upper and lower limbs for 2 weeks. MRI cervical
done 01-February-2015 showing severe cervical
stenosis C3-4 and C4-5 with spondylolisthesis
L1-2 with old infarction of the left
fronto-parietal lobes. CXR showing cardiomegaly.
On examination: the patient is in wheelchair for
2 weeks with weak all muscles left upper and
left lower limb 2-3/5with preserved sensation
and pathologic reflexes in the left side.
Exacerbation of deep reflexes left side.
Micturition was normal. Considering the bad
quality of the MRI and lack of information about
the dynamic status of the neck, another MRI
investigation and dynamic studies were performed
the day before surgery. MRI data support the
severe stenosis at C3-4 with hint
spondylolisthesis. Dynamic studies confirmed the
presence of considerable spondylolisthesis more
in flexion position.
Using the C-arm, the level of C3-4 was
identified and discectomy of C3-4 was achieved
until the dura was seen all over. To achieve
overdistraction of the posterior elements an
anatomical cage 6 mm height was inserted. Using
Atlantis cervical plate 25 mm length one level
and 4 screws 4x15 mm, fusion and reduction of
C3-4 was achieved. The wound was closed and the
patient was sent for intraoperative MRI. The
stenosis was resolved and the CSF was seen
anterior and posterior to the spinal cord. After
that, the patient was extubated.
Smooth postoperative recovery. The power of
left upper limb improved considerably.
The patient the second postoperative day showed
considerable deterioration of the left lower
limb power distal parts and to lesser degree of
the left upper limb. Decadron was started and
the patient showed considerable improvement at
the end of the day.
With bad information, the surgeon could
go to wrong surgical decision. It is a rule to check several
times and perform proper clear investigation to achieve the
best results with minimal intervention.
It was planned before surgery, that if
the stenosis persist, then to perform posterior
decompression. Intraoperative MRI ruled out the necessity
for the later procedure.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
Inomed MER system
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 .