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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05-JANUARY-2014 HANA IBRAHEEM HAMMADY 48 YEARS
SPONDYLOLISTHESIS L3-4 WITH SEGMENTAL STENOSIS L3-4, L4-5.
The patient came to the clinic 29-December-2013
complaining of LBP with right sciatica for 5
years with exacerbation last 2 years. Right
sciatica with numbness of the right right foot
the last 6 months.
On examination: the patient is limping with
scoliotic stance. SLRS was 40
degrees right side with pain and 65 degrees left
side with less pain. There is weak dorsiflexion
both feet 4/5 and planterflexion right foot 4/5.
MRI lumbar spine done 30-December-2013 showing
spondylolisthesis L3-4 with segmental stenosis
at L3-4 and L4-5.
Using C-arm, the L3-4 level
was identified. Laminectomy of L3 and L4.
Foraminotomy right L4, L5 roots. Discectomy of
L3-4 from the right with insertion of
Vitatech/France TLIF cage 10x30x50
from the right. Bone graft was added to both
sides of the cage. Monoaxial screws 6.5x45 mm
were inserted to L3,4 and L5 levels. Bended rods
5.5 mm were bended to accept the normal curve of
the spine. The left rod was exposed to spreading
in attempt to minimize the scoliosis. Slight
compression was applied at the right L3-4 level.
Cross connector with holders were applied. All
stages of surgery were done with C-arm control.
ISIS Inomed check screws was applied by using
the transpedicular set. The roots were
responding to 6 mA DNS. The screws did not
respond even to 15 mA DNS. There was a pinpoint
tear of the dura, which was repaired by nylon 4
recovery. The power of both feet became
The patient has scoliosis, spondylolisthesis and
stenosis. All of them must be corrected during
surgery, to obtain the maximal beneficial
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