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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29-JANUARY-2013 AYMAN RAJEH ABDAH 43 YEARS EXTRUDED
DISC C4-5 WITH SPINAL CORD COMPRESSION.
The patient came to the clinic 24-December-2012
complaining of neck and both upper limbs pain
for 5 months with exacerbation of the left
upper limb pain the last month with numbness of
the thumb left hand with numbness of the left
side of the body below the umbilical region. The
patient cannot sleep due to pain. The patient
underwent surgery for PLD L4-5 2 years ago and
cervical discectomy C5-6 and C6-7 with cage
insertion 3 years ago. The
patient is a known hypertensive for 10 years.
MRI cervical spine done 01-November-2012 showing
extruded disc C4-5 with severe
compression at C4-5 and malacia of the spinal
cord and inverted curve of the cervical column
from C4-7 segments.
On examination: The patient have weak grip right
hand 4/5, extension right hand 3/5, left hand
4/5 and the right triceps muscle 4/5. There is
hypalgesia of the median distribution right
hand. There is hypalgesia below the left nipple
with weak right leg 4/5 all muscles. Hoffmann
positive in the right with Babinski also in the
right with bilateral clonus more brisk in the
The patient was sent to perform MRI of the brain
with contrast, which was done 24-January-2013
partial study without contrast showing scattered
lacunar infarctions of no clinical significance.
Half of the old wound was
used to perform discectomy C4-5 with total
cleaning until the dura was seen behind the
bodies of C4 and C5. Samarys cervical cage
17x13x5 mm was inserted to C4-5 disc space.
Inspection of the old C5-6 was stable, but the
one at C6-7 was flail. Considering that the
inverted curvature of the spine fusion of
C4-5-6-7 was done using Trestle cervical plate
45 mm length with 4 fixed screws 16 mm
length to C5 and C6 and variable to C4 and C7
same length. The tightening was done to maximize
the reduction of the inverted curve to accept
the curve of the plate. All stages of surgery
were done using C-arm.
Routine closure of the wound.
Smooth postoperative recovery.
The power of upper limbs became normal.
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The patient has extruded
disc C4-5 with spinal cord compression and
inverted curve of the spinal column. Both must
be corrected to obtain the at most better
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