Munir Elias 20-12-2013

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Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses

Multigen RF lesion generator .





The patient came to the clinic 16-August-2014 complaining of right sciatica for 4 months. She was operated 3 years ago for spondylolisthesis in Saudi Arabia 3 years ago, after what the patient telling that she improved for 60% approximately, but deteriorated the last 4 months.


On examination; the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 40 degrees in the right with pain and 70 degrees with less pain. There is weak dorsiflexion right foot -3/5 and planterflexion same foot 4/5. There is hypalgesia right S1 root territory.


The patient was sent for new MRI of the lumbar spine with dynamic studies and CT-scan of the operated area and lab investigations. The CT-scan with reconstruction using ORS Visual showed the right upper screw touching the root. It was decided to explore the the site of surgery and resolve all her problems.


The old incision refreshed and the four screws exposed. The right rod was removed. Using Inomed ISIS transpedicular screw protocol, the right lower screw and both left screws did not gave EMG response even with 15 mA DNS stimulation. The right upper screw gave response even with 8 mA DNS stimulation. The construct is of Expedium brand. The type of the screw is polyaxial. It was removed and inspection of the screw cavity with feeler confirmed that it is located in the soft tissues. As seen in the figure below, the screw was inserted vertical to the sagittal plan and it was media at the level of the pedicle and outside the body of the L5. Foraminotomy right L5  and S1 roots. They were responding even with 1-2 mA DNS stimulation. Using Stryker XIA 3 system a new polyaxial screw 6.5x50 mm was inserted from near upper point and directed medially. All the screws now not responding even with 15 mA DNS stimulation. MAC cross connector 42 mm was applied to gain more stability of the construct. The harvested bone melt and applied lateral to the rods. Routine closure of the wound.


Smooth postoperative recovery with normalization of the power of the right foot.





The patient is a difficult case to estimate. Only with use of special software such as ORS Visual explained the real wrong position of the screw.


Foraminotomy is a must in these cases to eliminate all the compressive elements.

Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.

Leica HM500

Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014

CT-scan reformatted using ORS Visual showing wrong direction of the right upper screw.

The upper screw looking as be inside the canal, but this picture after removing the fractured fragments and the root was inspected visually and even the screw is thicker than the others, but it is actually inside the pedicle and the 15 mA DNS stimulation of the screw did not trigger any response.

Back Up!

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 .


















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