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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02-JUNE-2013 FARIDEH MUDHER FRAEH 65 YEARS
SPONDYLOLISTHESIS L3-4, L45 WITH EXTRUDED DISC L4-5 LEFT SIDE AND LCS L3-4
The patient came to the clinic 29-May-2013
complaining of LBP for 5 years with left
sciatica for 6 months. MRI lumbar spine done
28-March-2013 showing lumbar canal stenosis L3-4
and L4-5 with spondylolisthesis L3-4 and L4-5.
On examination: The patient is limping with
exaggerated scoliotic stance.
There is weak dorsiflexion both feet -4/5 more
weak in the left foot.
The patient was sent for MRI of the lumbar spine,
which done 30-May-2013 showing severe lumbar canal stenosis L3-4 and L4-5
with extruded disc L4-5 left side. Dynamic studies
spondylolisthesis L3-4 and L4-5. MRI right knee
showing effusion with degenerative changes.
of L4 and lower half of L3and upper third of L5. Foraminotomy
L4,5 both sides. All the
compressive elements were removed. The dura was
transparent with no epidural fat. Discectomy
L4-5 from the left with insertion of TLIF cage
Novel TTL 30x5x9 mm with bone graft for each
side of the cage. Using Isobar TTL module In, 6
monoaxial screws 6.2x40 mm were used to fuse
L3,4 and L5 bodies with slight compression of
L4-5. Easys cross connector 65 mm length and 2
rods bended to adopt the natural curve were used
to stabilize the construct. Bone graft was used
lateral to the rods. All stage of the surgery
were done under C-arm control. During right
lower screw fixation, the dura was injured by
the rod pusher and the 3 mm tear was repaired by
nylon 4 zero and check for CSF leak was
Routine closure of the wound.
Smooth postoperative recovery. The power of both feet became normal.
The patient has severe progressive lumbar
canal stenosis. The earlier the surgical
decompression the better the result.
The patient has minor degree of
spondylolisthesis. This due to stenosis, which
will escalate in case of decompression. For this
reason transpedicular fixation is a must to
avoid such postoperative event.
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