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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GHASAN MITHQAL DHEMISH 40 YEARS SPONDYLOLISTHESIS L5-S1 MANIFESTING
ITSELF ACUTELY AFTER DISC SURGERY.
The patient was operated by me
26-July-2013 for huge recurrent extruded disc L5-S1
with right foraminal occlusion. After surgery he
progressed agonizing left sciatica, for what
control MRI lumbar spine done after surgery,
ruling out any disc material compressing the
left S1 root. It was deciding taking the data in
his first and last second operation done
yesterday, that his spondylolisthesis of L5-S1
is the cause of his agonizing left sciatica.
The wound opened and extended
up with skeletonization of L4 lamina. Complete
laminectomy of the flail L5 lamina was done with
removal of the flail lateral masses of L5-S1
facets. There was complete bilateral
pediculolysis both sides. Foraminotomy both L5
roots and the left S1 root. Complete flavotomy
L4-5 was achieved. TLIF cage Novel TL 8x10x30 mm
inserted to L5-S1 disc space with bone graft to
both sides of the cage (BoneSave). 2
transpedicular monoaxial Spine Alphatec
6.2x45 mm inserted to L4 body. 1 monoaxial screw
6.2x45 mm inserted to the left side of L5 and
polyaxial 6.2x45 mm to the right side of L5
body. 2 polyaxial screws 6.2x40 mm inserted to
the S1 body. Using bended rods 5.5x60 mm with
cross connector, fusion of L4, L5 and S1 was
done. All the involved roots were checked and
all stages of surgery were performed using C-arm
Further bone graft was added lateral to the
Routine closure of the wound.
Smooth postoperative recovery. Regression of the
The patient had spondylolisthesis L5-S1 of minor
degree which was neglected at the first and
second surgery. The extrusion of the disc
material was huge at the first and second
surgery, for what the minor degree of
spondylolisthesis was ignored.
Escalation of the left sciatica which was not
explained by extruded disc raised the clinical
importance of the instability, which was
Some patients undergo local illegal procedures
such as hitting the back with wood baton, which
cause fracture of the laminae. This frequent
finding, made underestimation of the role of
spondylolisthesis and overmobility of the spine
in the clinical setup.
In the future, any disc surgery with flail bones
and abnormal bony movements must be corrected by
fusion and stabilization without considering its
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