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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28-MAY-2014 MUHAMED BASSAM TAHER 65 YEARS
RESIDUAL AFTER OLD AND RECENT SURGERY WITH SPONDYLOLISTHESIS L4-5 AND RECURRENT
EXTRUSION L5-S1.
Anamnesis
The patient came to the clinic 31-December-2013
complaining of LBP with left sciatica for 45
days. MRI lumbar spine done 22-December-2013
showing spondylolisthesis L4-5 with extruded
disc L5-S1. (Lumbarized S1). The patient is a
known diabetic with arterial hypertension for 7
years. Discectomy L4-5 done 20 years ago. Cath
done 7 years ago with stinting.
On examination at that time; the patient was limping with
exaggerated scoliotic stance. SLRS was 80
degrees in the right with shooting pain to the
left. Complete drop left foot with weak
dorsiflexion both feet -4/5. Weak dorsiflexion
right foot 3/5.
The patient was sent for investigations, but for
unknown reasons the patient disappeared.
The patient then came 24-May-2014 telling that
he was operated at KHMC 13-January-2014 with
slight improvement, then his condition
deteriorated the last week with inability to
walk. Using crutches and walking with aid. MRI
lumbar spine done 24-May-2014 showing the
spondylolisthesis with huge recurrence of L5-S1
with left foraminal occlusion.
On examination at this time, he is dramatically
worse with same weak feet as before with
hypalgesia left L5 and S1 roots territories.
Skeletonization of the lateral masses of L3-4,
L4-5 and L5-S1. The L5-S1 level was identified
using the C-arm. The extruded disc L5-S1 was
attacked from the left side and removal of the
extrusion and left sided cleaning L5-S1 disc
space. The disc space was filled with Hydr'Os 1
ml. Insertion of 6 transpedicular screws
monoaxial 6.5x45 mm Vitatech was done. During
creation of the path for the right upper screw,
a mixture of blood with CSF came out. It seems
that the insertion point was too medial, for
what another point was chosen more lateral. 2
bended rods were used with cross connector. All
stages of surgery were performed with C-arm
control.
Smooth postoperative recovery. The power of
right foot became normal and the drop foot got
slight movement, which was absent before
surgery.
Comments
The patient has spondylolisthesis L4-5
and huge recurrent extrusion at L5-S1, both need surgical
correction.
The drop left foot was for more than 8
months, it is rare to achieve dramatic improvement of the
power of the left foot. Time will tell.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
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 .
