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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09-DECEMBER-2011 SONYA BUGHUS GASHRANIAN 47 YEARS
SPONDYLOLISTHESIS L4-5 WITH RECURRENT PLD L5-S1.
Anamnesis
The
patient came to the clinic 29-October-2011
complaining of LBP for 2 months with left
sciatica and difficult standing and numbness of
the II and III toes left foot.
The
patient underwent CABG and discectomy L5-S1 for
right sciatica in 1996. MRI lumbar spine done
05-October-2011 showing spondylolisthesis L4-5
with complete segmental occlusion and recurrent
PLD L5-S1.
On
examination, the patient has scoliotic stance
and limping. SLRS was 90 degrees both sides
without pain. There is weak dorsiflexion left
foot -4/5 with hypalgesia left L5 and S1 root
territories.
Skeletonization of
L4,5 and S1 with partial of L3 posterior bony
structures down to the transverse processii both
sides. Laminectomy of L5 and lower 3/4th of L4.
Foraminotomy both S1 roots and left L5 root.
Discectomy of L4-5 and L5-S1 with meticulous
cleaning from the right side. Spineway TLIF
(Swingo) 10x21 mm inserted at L4-5 level and
8x21 mm at L5-S1 level aided with NeveBone.
Using transpedicular screws monoaxial 45x6 mm
were inserted to the L4 level. To the L5 level
monoaxial 45x6 mm was inserted to the left side
and polyaxial 45x7 mm to the right side. To S1
level 2 polyaxial 40x6 mm screws were inserted
with C-arm guidance. The rods were bended to
accept lordotic curve of the area and fusion was
achieved with slight compression and connector
was applied at L5-S1 level. The bone harvested
during laminectomy was milted and applied to the
disc spaces and lateral to the rods.
Routine
closure of the wound with several water-tight
layers. Smooth postoperative
recovery with improvement of the power of
the left foot.
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Comments
The patient had mobile spondylolisthesis at L4-5
causing severe segmental stenosis. She had also
recurrent PLD L5-S1. Both problems must be
corrected during surgery, for what decompression
and fusion was performed to include L4-5
and L5-S1 level.
The stress point now is shifted to L3-4, which
could trigger disc protrusion at this level.
There was no isthmolysis, but the L4-5 facets
were fractured in both sides. Pseudojoint was
the end result of this fracture and
overmobility. The bone was marble-like hard and
insertion of the screws was force.
Postoperative reformatted check CT-scan showing the construct.
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 .
