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-DECEMBER-2012 KHERIYE IBRAHEEM HAKOOZ 73 YEARS
SEVERE LUMBAR CANAL STENOSIS L2-3, L3-4 WITH SPONDYLOLISTHESIS L3-4.
The patient came to the clinic 06-December-2012
complaining of LBP for 10 years with bilateral
sciatica for 3 months more the right. She cannot
walk more than 300 meters with intermittent
claudication. Her condition is deteriorating.
The patient is a known hypertensive in
medication for 2 years and underwent right CT
release 30 years ago by me and right cataract
removal 1 year ago. She has tinnitus left ear
MRI of the lumbar spine done 22-October-2012
showing severe lumbar canal stenosis L2-3, L3-4
with spondylolisthesis L3-4.
On examination: the patient
is limping, walking bended anterior with
exaggerated scoliotic stance. SLRS was 85
degrees in the right with pain. There is weak
dorsiflexion both feet -4/5. There is severe OA
Skeletonization of L2,3,4 and
L5. Decompressive laminectomy of L2,3 and upper
half of L4. There was severe stenosis at L2-3
and L3-4 levels with kissing facets. There was
overmobility of L2-3 and L3-4. Foraminotomy of
the right L3 and L4 roots. Discectomy of L2-3
and L3-4 with insertion of TraXis 7x9x21 mm PEEK
TLIF to both disci with harvested bone graft and
NovaBone. 2 polyaxial Zimmer transpedicular
screws inserted to the L3 body. 2 fixed screws
were inserted to L2 body and one polyaxial to
the left side of L4 and monoaxial screw to the
right side of L4. All screws were 6.5x40 mm
length. The fusion was achieved with slight
compression with 2 rods 5 mm diameter and 65 mm
length. Cross connector 72 mm length was
inserted to obtain more stability to the spine.
The NovaBone and harvested bone was inserted
lateral to the rods.
Routine closure of the
wounds. Smooth postoperative recovery.
The power of both feet became normal.
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The patient has stenosis
with extruded disc at L2-3 and spondylolisthesis
of L3-4. Decompression and fusion of all
segments is the best option in this case.
Postoperative check X-ray showing the position of
the screws and the cages.
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