NEUROSURGICAL VIDEO GALLERY
DAILY OPERATIVE ACTIVITY
www.neurosurgery.tv
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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
02-MAY-2012 RUQAYA MUHAMED ALI AL-AKWAA
66 YEARS RESIDUAL AFTER OSTEOMYELITIS L2 WITH TRANSPEDICULAR
SCREWS FIXATION OF L1-L3 WITH SLIPPED BOTH LOWER SCREWS INFERIOR.
Anamnesis
The
patient
was
operated by me
04-July-2011 for fixation of L1 with L3
after complete destruction of L2 due to
osteomyelitis. The patient was operated at that
time after massive antibiotic therapy for
several weeks.
The
patient is a Yemeni citizen and she was followed
by telephone over the months and was kept in
Dalacine-C 300 , which did not tolerate after
4-5 months and replaced with erythromycin until
today, because the CRP and ESR became lower but
still high.
The
patient then came for follow up 24-April-2012
and she is still complaining of bilateral
sciatica more the left, but she can walk without
assistance.
On
examination, the patient
can walk
be herself. SLRS was 50 degrees in the right and
45 degrees with pain in the left. The power of
both lower limbs and sensation were preserved.
The
patient was sent for MRI of the lumbar spine
with contrast, CT-scan L1 down to S1 and LSS
X-ray dynamic study. They were done
26-April-2012 showing slipping of the lower
screws down about 5 mm in both sides, migrating
outside the pedicular territory, thus irritating
the roots at this level.
Exposure the construct and
the connector. Using Zimmer instrumentation of
Java Instinct was incompatible with the
screw drivers of Java 1 mentioned earlier, for
what, it was necessary to drill out the nuts and
the connector. Due to this mishap of production,
it was necessary to remove all the screws and
two Java Instinct Zimmer monoaxial 7.5x40 mm
screws inserted at the same place of L1. Four
polyaxial Java Instinct Zimmer screws 7.5x45 mm
were inserted to the L3 and L4 bodies. The rods
length was 110 mm both sides bended slightly to
adopt the natural local curvature. 62 mm
transverse connector was applied. All stages of
surgery were performed under image-intensifier
control.
Routine
closure of the wound. Smooth postoperative
recovery.
Pre and pereoperative localization of
the screws.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
connection.
Comments
The patient had in the
start osteomyelitis of L2 with complete
destruction and she could not even set down,
because the upper part of the lumbar spine was
completely flail and had pockets of pus in the
left psoas muscle. Surgery was mandatory,
because the patient was in miserable condition.
Osteomyelitis and osteoporosis were the
triggering factors for downward migration of the
lower screws for about 5 mm both sides. Even the
interbody part was inside the bone of L3, but
the pedicular part slipped down out of the
pedicles, irritating the running nearby roots.
Zimmer must respect their brands, so as to have
such conflict, that using one brand is mission
impossible to correct the other brand. At least
they must warn the neurosurgeon to be ready to
accomplish his task without falling into
troubles.
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 .