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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11-NOVEMBER-2013 KHALEEL AHMAD ABED ABU-THAHIRIYEH
70 YEARS SEVERE LUMBAR CANAL STENOSIS L3-4, L4-5, SPONDYLOLISTHESIS L3-4
WITH RECENT HUGE EXTRUSION D12-L1 WITH CAUDA EQUINA SYNDROME.
The patient came to the clinic 13-April-2006
complaining of intermittent claudication for 10
years. MRI lumbar spine done 06-December-2005
showed lumbar canal stenosis L3-4 and L4-5. He
could walk 30 meters after what numbness both
feet and bilateral sciatica took place. He had
scoliotic stance, SLRS was 60 degrees in the
right and 30 degrees in the left with pain. He
had hypalgesia left L5 root territory with weak
dorsi and planterflexion both feet 4/5. He had
dripping of urine for 1 year. He was advised to
undergo surgery, but he escaped.
The patient then came 02-March-2009 with further
deterioration with new MRI lumbar done
20-October-2008 showing the same stenosis. He
claimed that there was no micturition problems,
but he has hypalgesia at the right knee and a
little below the left knee. He had flail right
foot with severe weak left foot dorsi and
planterflexion 2/5. The patient is using
crutches for 1 year. The patient performed MRI
lumbar spine 03-March-2009 and given admission
for surgery, but he another time escaped.
The patient then came 06-November-2013 telling
that he got agonizing LBP with bilateral
sciatica more the left the last 4 days with
inability to void, for what Foley's catheter was
applied and inability to defecate. The patient
is in wheelchair. He has trigger III IV fingers
both hands. He has analgesia below L3 level with
fulminant cauda equina syndrome. Weak adductors
3/5 and flail both feet and abduction of the
limbs at the knees 0/5.
MRI cervical, dorsal and lumbar spine done 06-November-2013 showing
cervical canal stenosis at C4-5, C5-6, dorsal
showed huge extruded disc D12-L1 with severe
compression of the spinal cord more to the
right. The old lumbar canal stenosis at L3-4 and
L4-5 still the same with spondylolisthesis L3-4.
Laminectomy D12 and upper
half of L1 with the guidance of the C-arm.
Foraminotomy of the right L1 root. The extruded
disc of D12-L1 was removed from the right .
There was no epidural fat and the up and
downward migrating pieces were removed.
recovery. The power of both feet became better.
The patient has huge recent extruded disc D12-L1
causing the fulminant cauda equina syndrome.
This takes precedence for surgery.
Since lumbar canal stenosis is near the filed,
decompression and fixation can be done at the
same surgery. The patient for paramedical
reasons was willing to be operated only for
extruded disc D12-L1.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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