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
The patient is a doctor, how was operated elsewhere for severe CCS, 13-October-2004. The patient neurologic condition deteriorated after surgery and repeat MRI performed 4-April-2005 showed still persisting compression at C3-4 and C6-7 and furthermore escalation of spinal cord compression due to slippage of further disc material during insertion of the cage. The weakness of the right upper limb deteriorated dramatically. This could be understood when seeing the fragments at the level of C3-4 right side. The patient was seen 09-April-2005 with power of both deltoids =1, both biceps brachii =1 grip both hands =3 and extension both hands =0 and triceps both upper limbs =2 and analgesia of the upper extremities below the mid of the forearms. Atrophy of the interossii muscles and inability to hold the arms up. The quadriceps femores were 4 and abduction of the knees was 4 with weak dorsi and planterflexion of the right foot. Hypalgesia of both lower limbs was noted below knee both sides. The patient went for secondary pinions and came 2 days ago with further deterioration of his condition. The patient was operated and it was necessary to reach the lesions through the previously performed incision, which was located very low to reach the C3-4. After decompressing the C6-7 level, using the high-speed drill to remove the calcified disc space bony degenerated material with the cage. The dura was decompressed in wide area, about 15 mm height at that level. The C3-4 level was reached through the same incision, but using different route of cleavage. Despite the transnasal intubation, it was very difficult to work parallel to the disc space cleavage due to low location of the skin incision. All the compressing elements and the extruded disc were removed along with the OPLL with decompression succeeding 20 mm at that level. Using cervical miniplates and screws fusion of C3-4 and C6-7 was performed separately. The patient immediately after the operation showed considerable improvement of his neurologic status.
Comments:
Use transnasal intubation, when you intend to work in wide area in the cervical spine.
Put the incision, so that to ease the visual access to all levels undergoing surgery.
The integral part in OPLL is decompression, not just inserting cages or fixation. All the compressing elements must be removed and wide area of decompression must be achieved.
Using cages of different modifications, including the versions with screws for fixation are full of hazards and they must be abandoned from practise. They are not only useless, but several cases seen by me were the victims of neurologic deterioration and even death as in the case of one doctor operated upon elsewhere due to various technical defects, hiding in this concept.
The cervical miniplates with screws manufactured by several companies, remain the safest way for fixation over the last 20-25 years.
