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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28-NOVEMBER-2013 MUNTHER MUHAMED FAYYEQ 40 YEARS
SLIPPED RODS AFTER TRANSPEDICULAR FIXATION.
The patient was operated by me
23-August-2013 for spondylolisthesis L5-S1
and extruded disc L4-5. Transpedicular screw
fixation L4,L5 and S1 was done with insertion of
TLIF at L5-S1 level, using Alphatec Spine Isobar
TTL module in system. The patient noticed
escalation of right sciatica 12-September-2013.
Check X-ray done 19-September-2013 showed
slipping of the rods: the right slipped down 10
mm and the left up for the same distance, but it
was not noticed by me at that time. Check for
infection was negative. The patient was treated
conservatively. The patient then came
24-November-2013 claiming that the LBP and right
sciatica still the same last month and he is
feeling click in the back. The right sciatica
persist even when sleeping. Control X-ray done
23-November-2013 showing the same picture as
before with more slippage of the rods. The
transpedicular screws are in good position. SLRS
was 80 degrees both sides with pain in the left.
There is no sensory motor deficit.
MRI lumbar spine done 25-November-2013 ruled out
escalation of other events.
The old incision refreshed
and the nuts exposed. The left rod was shifted
up and out of the lower nut. The same finding
was seen in the right upper nut. The connector
was in place with the left nut was loose. All
the nuts in the left rod were loose, but in
place. The connector, all nuts and both rods
were removed. The transpedicular screws were in
good condition. The old rods were 5 cm length.
New rods 65 mm long with more bending than the
previous ones were inserted and about 15 mm away
from the upper and lower nuts were fixed tightly
and new cross connector was applied. Vigorous
physical strain was applied after that, to
ensure that no loose elements are present.
Routine closure of the wound. The stages of
surgery were documented by the C-arm.
It is the first time happening that both rods
slipped out the nuts. It is recommended to
change the rod construction to be beaded, to
prevent escalation of such events, or at least
to have rods with several lengths with widened
spherical endings, to prevent outside slipping
of the nuts.
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