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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18-AUGUST-2010 NADEEM SPER SALEH 60 YEARS
POST-TRAUMATIC SPONDYLOLISTHESIS WITH SEGMENTAL INSTABILITY OF C7-D1 AND
MYELOPATHIC SYNDROME.
Anamnesis
The
patient came
to the clinic 07-August-2010 complaining of
difficult walking and profound weakness both
lower limbs after falling down 08-November-2009
in Saudi Arabia and was diagnosed and treated
for polyradiculopathy with betaferon and
prednisolone. The clinical course continued to
deteriorate despite this modality of treatment.
On examination: the
patient walking with help. Romberg was not
performed due to inability to stand. There is
hypotrophy of interossii both hands with weak
grip, extension of the hands and triceps both
arms 4/5. There is analgesia below D3 left side
and hypalgesia in the right side at the same
level with dense anesthesia below the right
knee. The right quadriceps is weak 3/5 and the
left -4/5 adduction and abduction right knee 3/5
and left knee 4/5. The dorsi and planterflexion
right foot -3/5 and left foot 3/5. SLRS was 60
degrees in the right due to weakness and 80
degrees in the left due to weakness. There is
positive Babinski right side with hypotonia of
the left foot.
The patient was sent
for MR investigations, which confirmed the
presence of unstable spondylolisthesis of C7-D1
with compression of the spinal cord and malacia
of the spinal cord at this level.
Intradiscal decompression of C7-D1 with
insertion of Fidji cage 17X12X6.9 mm to disc
space after what the alignment of the dislocated
bodies became more acceptable. Trinica one
level 22 mm length Trinica cervical plate was
used with for 16 mm screws to achieve fusion of
C7-D1. During tightening of the screws more
reduction of the dislocated structures was
noted. Routine closure of the wound.
Smooth postoperative recovery and improvement of
the power of four limbs with prompt
normalization of the power of the upper limbs.
Comments
The patient was treated
empirically for polyradiculopathy without asking
him about the history and without morphological
examination for 9 months. MRI investigation of
the whole CNS is mandatory to avoid such
mistakes
The stenosis and dislocation
of C7-D1 caused spinal cord malacia and the MRI
was performed in the supine position. The
picture mostly will be more gloomy if the
investigations were performed in the standing
position.
The repeated mechanical
trauma was the cause of his progressive
neurological deterioration.
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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 .
