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

The patient began to deteriorate 2004, when he started to complain of neck pain and progressive quadriparesis with inability to walk and severe weakness of the right upper limb and both lower limbs.

MRI performed showing malacia of the spinal cord and syringomyelia with severe stenosis and compression at several levels more at C3-4 with inverted curvature of the cervical vertebral column.

Considering that the patient has severe stenosis especially at C3-4 level, it was decided to perform posterior redecompression. The patient was put in supine position and posterior approach was performed and all the bony compressing elements were eliminated. Duralysis was performed circumferentially after what, the dura regained relaxed appearance.

During surgery, severe overmobility of the cervical segments was noted and it was noted that the lateral masses are tiny, not standing for posterior fusion, for what, the wound was closed and anterior approach was performed and anterior fusion of C3-7 was performed with mild binding, resembling the normal curvature of normal cervical column. The C4-5-and 6 came up and rigid fixation with acceptable alignment was achieved. Routine closure with smooth postoperative period.

Comments:

1. In this case, direct anterior fusion without inspecting the posterior elements and decompressing all the bony parts, especially at C3-4 could result in further trauma to spinal cord and disturbed respiratory drive, for what it was logical to perform posterior exploration and decompression.

2. Posterior fusion was impossible, because his lateral masses were tiny, not withstanding the construct for posterior fusion, further more to regain the normal curvature of his inverted alignments.

3. Anterior fusion, after securing the spinal cord from behind, gave excellent reduction of his inverted curvature, which was beside overmobility, the determinant cause of his chronic damaging factor to his spinal cord.