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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WAFIQ UTHMAN JABER 54 YEARS HUGE PCD C5-6 WITH RIGHT BROWN-SEQUARD
The patient came to the clinic 24-January-2013
complaining of neck pain for 3 years, cephalic
pain and left shoulder pain for 1 month.
Numbness of both legs for 2 weeks progressing up
to involve the upper limbs the last weeks more
the left hand.
On examination: the patient using crutches for 2
days, limping with wide based legs gait. He has pain when
looking up and to both sides more to the left with weak grip
and extension both hands 3/5 and both triceps
3/5 right , -3/5 left and the left biceps 4/5.
Weak both quadriceps 4/5 and dorsi and
planterflexion both feet 3/5 more weak in the
left. There is hypalgesia ulnar side of the
right upper limb and paraaneasthesia below the
nipples. Hoffmann positive both sides and all
deep reflexes are exaggerated and Babinski
positive both sides. Clonus of the feet. SLRS
was 30 degrees both sides due to weakness.
The patient was immediately sent to perform MRI
of the brain with contrast and MRI of the
cervical spine, which was done after 3-4 hours
to show a very huge extruded disc C5-6 with
malacia of the spinal cord.
Discectomy of C5-6
was done until the dura was seen along all the
posterior aspects. Samarys cervical cage 17x13x5
mm was inserted to C4-5 space and 17x13x6 mm to
C5-6 level. Trestle 1 level cervical plate 30 mm
length was used with 4 variable 4x14 mm
screws inserted to C4 and C5 bodies and 3 fixed
4x14 mm to C5 body. All stages of surgery were
done under C-arm control.
Routine closure of the wound.
Smooth postoperative recovery. The power of the
upper limbs became normal and the shooting
pain to the left shoulder dramatically
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The patient has extrusion
of C5-6 causing the tetraparesis.
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