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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07-OCTOBER-2012 MAHMOUD ALI SAEED 67 YEARS
SPONDYLOLISTHESIS L4-5 WITH SECONDARY STENOSIS.
The patient came to the clinic complaining that
he deteriorated after performing decompression
for lumbar canal stenosis of L4-5 in 2006. The
right sciatica increased and bilateral sciatica
the last 4 years. The patient is using crutches
for 3 years and cannot walk more than 50 meters.
The patient is a known diabetic with
L.S.S. X-ray done 30-September-2012 showing II
degree spondylolisthesis of L4-5.
MRI of the lumbar spine done 30-September-2012
showing severe stenosis L4-5 and old extruded
disc L1-2 of no clinical significance.
On examination, the patient is limping with
exaggerated scoliotic stance. SLRS was 60
degrees with pain in the right and 75 degrees in
the left. There is severe weak dorsiflexion both
feet 2/5 and planterflexion both feet -3/5.
There is hypalgesia both feet at the level of
the ankles with edema of both ankles. There is
severe OA both knees.
The patient was sent for cardiologic and
nephrologic consultation, because there were
subclinical signs of renal failure with elevated
all hepatic enzymes with uric acid reaching 13.4
mg/dL. The patient was admitted 3 days before
surgery under the supervision of the
nephrologist. MRI of the brain with MRA were
compatible with age.
Skeletonization of L5, L3 and
the remnant of L4. There is massive scar in the
right side of L4-5. Foraminotomy of the right L5
root. There was severe compression of the root
by extruded disc and destroyed right lateral
mass. All compressive elements were eliminated.
Discectomy of L4-5 from the right with
meticulous cleaning. TLIF cage Novel TL 10x25 mm
was inserted from the right to the disc space.
Using Scientex Alphatec Spine Isobar TTL,
2 polyaxial screws 6.5x45 mm were inserted to L5
body. 2 monoaxial screws 6.5x45 mm were inserted
to L4 body. Rods 5.5 mm with Easys cross
connector were used to obtain fixation with
slight compression. Life net bone graft
was used to fill the disc cavity and the gaps
lateral to the rods.
Routine closure of the wound. Smooth
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The patient has many
problems among them eminent renal failure. This
and other pathologies will act negatively in the
recovery process of the patient.
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