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
The
patient was operated
27-July-2010 for severe
cervical stenosis, after what considerable
improvement was noticed. She had also lumbar
canal stenosis, which was considered to be
reevaluated later.
The
patient then came 10-October-2011 claiming that
the upper limbs and the neck are in good
condition, but still complaining of cramps of
both lower limbs with LBP.
MRI
lumbar spine done 13-July-2011 showing severe
lumbar canal stenosis L3-4 and L4-5.
On
examination: the patient is limping with
scoliotic stance. There is bilateral sciatica
with SLRS 75 degrees in the left with pain, but
weak dorsiflexion right foot 3/5 and
planterflexion right foot 4/5 and anaesthesia of
right L5 and S1 territories.
Decompressive
laminectomy of L4 and partial of L3 and L5.
Foraminotomy of L4 and L5 roots both sides. The
right L4 foraminotomy was extended far lateral
so as to decompress the severely deformed root.
Only 8 mm width of the pedicle was left to
preserve stability to the bony construct.
Routine
closure of the wound. Smooth postoperative
recovery and improvement of the power of
the right foot.
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Comments
The patient has lumbar canal stenosis, which is
a progressive one. The surgery was postponed to
resolve the cervical canal stenosis which must
take precedence.
The sooner the decompression, the better the
postoperative outcome. Foraminotomy is mandatory
in most cases, because the roots most of the
time are compressed.
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 .
