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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12-JANUARY-2014 NABILA ABDEL-AZZIZ AHMAD AL-SAANE 68 YEARS
SPONDYLOLISTHESIS L4-5 WITH BULGE L3-4 WITH SEGMENTAL STENOSIS..
The patient came to the clinic 30-September-2013
complaining of LBP for several years with
exacerbation of the LBP with bilateral sciatica
more the right for one year. The patient is a
known diabetic, with arterial hypertension for
10 years. Bilateral renal stones with acceptable
On examination at that time: the patient was
limping with exaggerated scoliotic stance. SLRS
was 75 degrees with pain in the right. Weak
dorsi and planterflexion right foot 4/5 and +4/5
MRI lumbar spine done 07-January-2014 showing
spondylolisthesis L4-5 with bulge L3-4 and L4-5
with segmental stenosis. Dynamic studies showed
10 mm mobility of the L4-5 spondylolisthesis.
MRI brain showed scattered small old lacunar
infarctions of no clinical significance. MRA of
the left CA showed complete occlusion above the
bifurcation of CCA-ICA with good contralateral
Using C-arm, the L4-5 level
was identified. Decompressive laminectomy L4,
upper third of L5 and lower third of L3.
Foraminotomy L4 and L5 roots was achieved at
both sides. Using ISIS Inomed IOM, with
transpedicular set, the roots were responding to
2mA DNS except the left L5 root was responding
to 4 mA. Discectomy of L4-5 from the right with
insertion of TLIF cage Novel TL 9x5x28 mm
dimension. 2 polyaxial screws Isobar TTL module
in 6.2x50 mm inserted to L4 body. 4 monoaxial
screws 6.2x45 mm inserted to L3 and L5 bodies. 2
rods 100x5.5 mm were bended to accept the
natural curve of the spine and cross connector,
transpedicular fixation of L3,4 and L5 was done
with slight compression between L4-5 level. Bone
graft was applied where necessary. At all stages
of surgery the roots were responding to 2 mA DNS
and screws showed no response even to 15 mA DNS.
Routine closure of the wound.
recovery. The power of both feet
The patient has severe canal stenosis with
spondylolisthesis at L4-5. All presenting
problems must be taken to consideration and
Using Inomed ISIS at all stages of surgery,
permit to catch the moment when any neurologic
deterioration took place and why.
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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 .