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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26-MARCH-2013 AYSHE JABER HASAN 50 YEARS
SPONDYLOLISTHESIS L4-5 WITH COMPLETE SEGMENTAL STENOSIS.
The patient came
to the clinic 09-March-2013 complaining of LBP
for 3 years with exacerbation the last 18 months
with numbness both feet more the left with
inability to walk more than 100 meters.
MRI lumbar spine done 10-May-2011 showing
spondylolisthesis L4-5 with complete segmental
stenosis. LSS X-ray showing grade II by
On examination: The patient is not limping with
no scoliotic stance. SLRS was 90
degrees in both sides. There is weak
dorsiflexion right foot 4/5 and left foot -4/5.
Investigations were repeated 10-March-2013
confirming the previous data.
Laminectomy of L4 and L5 with
foraminotomy L5 roots both sides. The ligamentum
flavum of L5-S1 was left untouched. The disc
space of L4-5 was attacked from the left. It was
very narrow and it was approached by using
spreaders different diameters to perform
discectomy of L4-5. Using Preservon allograft
LifeNet Health the right side of the disc cavity
was filled by it. Using the shortest TLIF cage
Novel TL 7x12x25 was inserted to the disc space
from the left. This was intentionally done avoid
complete reduction to avoid stretching of the
nerves and subsequent complications from
over-reduction. Using transpedicular screws
IsoBar Scientex 6.2 x40 mm to the left and
6.2x45 to the right of L5 body of polyaxial
version. 2 monoaxial 6.2x40 mm screws were
inserted to the L4 body. Using 2 rods bended to
accept the natural curve of the area, fusion of
L4, L5 was done. The same bone graft was used
lateral to the rods.
Routine closure of the wound.
Smooth postoperative recovery. The power of both
feet became normal.
Postoperative Check X-ray showing the construct in
The patient has high grade of spondylolisthesis.
Complete reduction could trigger unnecessary
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