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  neurosurgery.tv

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Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

22-APRIL-2015  MSHARI IBRAHEEM ABDALLA  35 YEARS  VERY HUGE EXTRUDED DISC C4-5 WITH MALACIA OF THE SPINAL CORD AND TETRAPARESIS.

 

Anamnesis

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The patient came to the clinic 20-April-2015 complaining of numbness four limbs for 10 months. He noticed slight improvement, than after 2 months got deterioration with ataxic gait and feeling tightness of the whole body. MRI lumbar spine done 09-October-2014 showing bulge L4-5. Cervical MRI bad quality showing PCD C4-5 with gross malacia of the spinal cord. MRI dorsal spine done 15-April-2015 showing bulge D7-8.

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On examination: the patient is limping as dragging both lower limbs. Romberg test : the patient swaying to all directions.  There is mild pain when turning the head down and bending the head to the left shoulder. The biceps are 5/5, but the grip, extension and triceps both upper limbs -3/5. There is weak dorsiflexion both feet -4/5 both feet and planterflexion right foot 4/5. There is hypalgesia both hands median distribution. Hoffmann test positive both sides. The deep reflexes are exaggerated all over. The 2 point discrimination was lost in the left leg.

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The patient was sent for new investigations with thorough protocol to rule out MS of the CNS and to have better idea about the spinal cord problem. These were done and the brain was normal and there was a very huge disc C4-5 with severe compression of the spinal cord with malacia of the spinal cord at the level of compression. There is a bulge of C7-D1 of no clinical significance.

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Using the C-arm, the level of C4-5 was identified and discectomy of C4-5 was achieved until the dura was seen all over. 1 Solis cage 5 mm was inserted to the disc space with bone graft. Reflex 1 level plate 18 mm length with 4 fixed 4x16 mm screws were used to fuse C4-5. All stages of surgery were done with C-arm control.

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Smooth postoperative recovery. The power of four limbs improved considerably.

Follow Up

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The patient motor recovery was immediately after surgery.

 

Comments  

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In the previous investigations due to bad quality MRI there was discrepancy between the massive malacia of the spinal cord and the non convincing spinal cord compression, which led us to perform new investigations to rule out MS or transverse meylitis and to demonstrate the big extrusion of C4-5.

 

Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.

Leica HM500

Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014


Inomed MER system


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Notice: Not all operative activities can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also escaped from the plan .

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