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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15-DECEMBER-2013 INAAM DAWOUD SULAYMAN 68 YEARS
SEVERE AGONIZING RIGHT SCIATICA AFTER TRANSPEDICULAR FIXATION FOR SPONDYLOLISTHESIS L5-S1.
Anamnesis
The patient was operated
09-December-2013 for spondylolisthesis L5-S1
by using TLIF of rectangular type of Kisco
Dualys. The patient after surgery continued to
complain of right sciatica, which escalated over
the days. MRI of the lumbar spine and X-rays
showed uneventful information. But it was noted
that the TLIF was setting in the right side of
the disc cavity. The patient after 2 days of
relative improvement started to suffer of
agonizing right sciatica. CT-scan with 3-D
reconstruction done 15-December-2013 showed some
bony elements at the right S1 course. It was
decided to explore the wound.
The wound was opened and
inspection of the right S1 root showed fracture
of the right lateral mass remnant with
compression upon the right S1 root. The fracture
elements were removed. The right rod and the
connector were removed. and the inferior screw
was slightly loosened. Using Inomed ISIS
transpedicular set, it was possible to have DNS
stimulation of the right S1 root at 5-6 mA.
Applying 15 mA to the screws did not show any
EMG response. The rectangular TLIF of Kisco
Dualys was removed with ease. An Alphatec Spine
TLIF cage Novel TL 6x23x10 mm was inserted
instead, trying to push it more medially. The
removed rod returned back and more compression
was applied to the right side. The connector
returned back and routine closure of the wound.
Smooth postoperative
recovery. The agonizing right sciatica
disappeared.
Preoperative showing the bone fragments after fractures
right lateral mass.
Postrevision showing air instead of the bone
fragments. Done 17-Dec. 2013
Comments
The cause of the sciatica was fracture of the
right lateral mass with bony compression of the
right S1 root, due to insertion of the
rectangular Kisco Dualys TLIF. This
fracture was not evident during surgery and
final inspection at the end of first surgery. It
could be the removed TLIF played a role in
triggering such a fracture or displacement of
the fracture pieces after surgery.
In the first surgery, it was wise to apply
compression in the screws first from the right
side, which was not the case. The compression in
the first surgery was applied from the left,
then from the right.
The patient the next day showed signs of
allodynia, for what transcocygeal epidural
injection of Marcaine 0.5% 15 ml and Depomedrol
80 mg was performed 17-December-2013.
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