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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23-FEBRUARY-2013 JAMEEL AHMAD JAWASH 58 YEARS
DETERIORATION AFTER DISCECTOMY C3-4 AND C4-5.
The patient was operated by me 20-January-2013
for extruded disc C3-4 and C4-5 with OPLL. The
patient showed dramatic improvement after
surgery with dramatic recovery of the four
limbs. The 5th postoperative day, he showed
severe deterioration of the power of the left
upper and lower limb.
On examination 05-February-2013: The patient is
limping with inability to walk alone due to
severe weak left side of the body. The patient
is unable to extend or flex the left hand. The
power of the left foot is 5/5 but the quadriceps
is weak 3/5. There is hypalgesia of the thumb of
the left hand and both feet. The power of the
right limbs are normal. Babinski positive in the
left side. The patient sent for investigations.
MRI brain done 10-February-2013 was uneventful
with sinusitis. MRI cervical spine showed de
novo posterior compression behind the C4-5
level. This elements was not seen in the
preoperative MRI. There is also edema of the
OPLL elements with slight edema of the spinal
C3,4,5 and upper half of C6 and lower third of
C2. There is no epidural fat and the dura have
Routine closure of the wound.
Smooth postoperative recovery.
The neurological status of the patient still the
Usually deterioration take place immediately
after surgery if iatrogenic injury is the cause.
Here the deterioration took place 5 days after
dramatic improvement. Edema of the OPLL
structures is not reported in the literature,
but here it is well demonstrated by the MRI
findings. This edema could take gradual onset
and it is not clear why it became swollen.
The area is fixed by plate and screws and the
posterior compression also cannot be understood,
why it emerged after surgery. MRI is still not
reliable for reading. This posterior compression
could have place before surgery, or it is de
novo event. The presence of this posterior
compression mandate posterior decompression.
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