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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KATIA ALI AL-MAQUSI 20 YEARS TETHERED CORD SYNDROME DOWN TO THE L3.
The patient came to the clinic 12-July-2002
complaining of LBP for 2 years after falling
down. On examination she was neurologically free
and there was slight elevation of the mid back
due to fatty hypertrophy. The patient was sent
to perform MRI of the lumbar spine and done
19-February-2007 showing showing spina bifida of
L2,3 and L4 with tethered cord to the dura
behind of L3 body. The patient was advised to
keep in conservative treatment and to be
followed if any deterioration taking place.
The patient then came 23-January-2013
complaining of intrascapular pain for 45 days
with occasional left hip pain. The lump in the
back still the same, but there was weak
dorsiflexion both feet 4/5 with hypalgesia both
The patient was sent for new MRI of the dorsal
and lumbar spine with LSS X-rays dynamic
studies, which done 23-January-2013, showing
slight tightening of the tethered cord at the
same L3 level.
Exposure of the dura above
the defect after partial laminectomy of the
deformed L3 lamina. The dissection was carried
down until circumferential exposure of the
lipoma and the dural boundaries with it were
seen visually. The extradural lipoma was
resected off to increase the visual control of
the surgery. Longitudinal incision above and
below the lesion and small remnant of the dura
was kept around the defective spinal cord to
preserve all the running roots above and below.
The dorsal rootlets were running to the upper
direction, which means that the dura was
severely pushed downward. The arachnoid was
dissected around the spinal cord and root s to
further untether the minor elements. All these
elements were pushed inside the dura and the
dura was water-tightly closed by 3 zero nylon.
Using head up position and Valsalva maneuver, no
CSF is coming out.
Routine closure of the wound.
Smooth postoperative recovery. The power of the
feet became normal.
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The patient had clinically
silent tethered cord syndrome with the spinal
cord with lipoma adherent at the level of L3. It
started to show deterioration in this age, which
could be due to her height growth in this age.
Untethering is now indicated.
For more detailed information about tethered
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