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
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07-OCTOBER-2013 HASNEH AHMAD AL-HARAHSHEH 57 YEARS
SPONDYLOLISTHESIS L4-5 WITH SECONDARY STENOSIS.
Anamnesis
The patient came to the clinic 26-September-2013
complaining of LBP for 2 months with right
sciatica.
MRI lumbar spine done 19-August-2013 showing
spondylolisthesis L4-5 with severe segmental
stenosis.
On examination: the patient is limping with
scoliotic stance. SLRS was 40 degrees with pain
in the right and 60 degrees with pain in the
left.
She has weak dorsiflexion right foot
3/5 and planterflexion right foot 4/5. She has
hypalgesia right L5 and S1 territories.
Skeletonization of L3,L4, L5 with laminectomy
L4, L5 with foraminotomy both L5 roots. The L4-5
disc was attacked from the left side. Discectomy
L4-5 was done. Insertion TLIF Alphatec Spine
10x17x15 mm with BoneSave to L4-5 disc space.
The space near the device was filled with bone
graft. Using 4 screws 6.2x45 mm monoaxial,
transpedicular fixation of L4, L5 was achieved
with 2 rods 60x5.5 mm, bended to accept the
normal curve of the spine. Cross connector was
added with minimal compression. BoneSave was
added lateral to the rods. All stages of surgery
were guided by C-arm. Routine closure of the
wound.
Smooth postoperative
recovery. The power of both feet became
normal.
Comments
The patient has minimal spondylolisthesis, but
with gross clinical manifestations. Micromotion
could irritate the neural structures.
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