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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29-APRIL-2010 HUSNI HAMED AHMAD 70
YEARS SEVERE CERVICAL CANAL STENOSIS C3-4 AND C4-5.
Anamnesis
The
patient was
operated by me
19-July-2007 for PCD C4-5, C5-6 and C6-7
with subsequent fusion of C4 down to D1.
The patient is a
known diabetic with glaucoma both eyes with
arterial hypertension.
The patient then
came 02-July-2009 with LBP and left sciatica
with MRI lumbar spine performed 29-June-2009
showing lumbar canal stenosis L2-3 and L3-4.
There was weak dorsiflexion right foot 4/5 and
left foot -4/5. The patient was treated
conservatively.
The patient then
came 25-March-2010 complaining of numbness of
the neck and right shoulder, which disappear
when using the collar. He was also complaining
of bilateral sciatica. The patient is claiming
that his condition is deteriorating, but the
weakness of both feet still the same.
MRI
cervical spine
performed 04-April-2010 showed severe stenosis
of C3-4 and C4-5 more from the posterior elements.
The patient has glaucoma both eyes for what
acetazolamide was started one day before the
surgery to prevent ocular complications from the
operative positioning.
Using MEP-SEP Inomed highline IOM after careful
intubation, the patient was positioned to
laminectomy position with slight flexion. N20
and P40 were delayed from the start in the left
side. Decompressive laminectomy C3-4-5 and
partial of C2 was done. Drilling of the bone was
achieved, so that zero surgical trauma was
applied to the stenotic parts. There was no
epidural fat at the entire of the exposure. 2 mm
medial to the lateral masses were lift
untouched. The IOM data were the same all the
time. Routine closure of the wound.
Smooth postoperative recovery with no
complications.
Comments
The patient had
previously stenotic canal from anterior for what
anterior decompression was done with fusion of
the cervical spine from C4 down to D1. The
age and the transfer of the stress points to the
above levels with slight osteoporosis were the
result of such stenosis.
Cervical canal stenosis is
progressive disease and when it clinically
progressing surgical interference is the
appropriate solution.
Great care was applied to the
glaucoma and the neurological status of the
patient to prevent catastrophic sequel
when dealing with such case.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
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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 .
