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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
05-JUNE-2014 BAHIYE ZAYDAN DAYEH 62 YEARS
SPONDYLOLISTHESIS L5-S1 WITH STENOSIS L4-5 AND STRUCTURAL SCOLIOSIS LUMBAR
SPINE.
Anamnesis
The patient came to the clinic 11-May-2014
complaining of LBP with bilateral sciatica for 5
years for what she was operated in Huston
USA in September-2013. The patient claim that
she got drop right foot after surgery and she
did improve for numbness, but the LBP and
bilateral sciatica persisted and increased and
the difficulty to walk became more evident.
On examination; The patient is limping
with exaggerated scoliotic stance. SLRS was
90
degrees in both sides without pain. There is
drop right foot with planterflexion same foot
4/5, weak dorsiflexion left foot 3/5. Hypalgesia
L5 root right side.
MRI lumbar spine done the same day with
contrast, showing spondylolisthesis L5-S1 grade
II with foraminal stenosis right L4-5. CT-scan
and dynamic studies showed bone graft at the
lateral areas of L5-S1 with presence of
instability.
Neurolysis of the right L5, S1 roots was
performed after exposing all the lateral masses
of L3-4, L4-5, L5-S1 and upper sacrum. During
neurolysis of the right L5 root a 1 mm tear of
the scar was noticed and repaired by 4 zero
nylon. The
nerves were studied using Inomed ISIS system and
the right L5 root was responding occasionally to
4 mA current DNS. The right S1 root was
responding well to 2mA DNS, which means severe
damage to the right L5 root. The bone graft used
at first surgery was mobile and with
pseudojoints. Using Stryker Xia 2 system, 4
monoaxial 6.5x45 mm length were inserted to L4
and L4. 4 ployaxial 6.5x40 mm were inserted to
L5 and S1 segments. Bended rods were applied and
slight distraction in the left aside between
L5-S1 was applied. Distraction of all segments
in the right side to eliminate the scoliotic
curve. Cross connector was applied. Routine
closure of the wound. All stages of surgery were
done using C-arm control.
Smooth postoperative recovery. The power of left
foot became better.
Comments
The patient has several problems, most of
them could be corrected surgically. The exposed severely
damaged right L5 root is not among them. All other problem
were taken to consideration and corrected surgically.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
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 .
