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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27-JULY-2010 AMNEH MAHMOUD ABDALLAH 55 YEARS
OPLL WITH SEVERE CERVICAL STENOSIS C4-5, C5-6 AND C6-7 WITH HUGE EXTRUDED DISC
C5-6 CENTRAL MORE TO THE RIGHT.
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Anamnesis
The
patient came
to the clinic 05-July-2010 complaining of right
sided paralysis for one week. MRI cervical spine
performed 01-July-2010 PCDs with severe CCS -
pictures are of bad quality.
On examination: the
patient walking with the help of 2 persons,
complaining of neck pain with complete paralysis
of the right hand and weak biceps 4/5 and
triceps 3/5 of the right upper limb. There is
weak dorsi and planterflexion right foot 3/5
with quadriceps right leg 4/5. There is
hypalgesia of the right hand and the left side
of the body below D1 manifesting Brown-Sequard
syndrome at the level of C5-6.
MRI of the brain
performed 14-July-2010 was normal and MRI of the
cervical spine showed OPLL with severe stenosis
at C4-5, 6-7 and huge extrusion C5-6 with
severe spinal cord compression of this level.
Cardiologic consultation was uneventful, despite
the fact, that she is a known diabetic with
hypertension and catheterization done 1 year ago
which was non significant. The anticoagulant was
not stopped before surgery.
In supine position with traction applied to the
skull 7 Kg, anterior discectomy of C5-6 was done
and all the compressing elements were removed
until the dura was free of any compression.
Intradiscal decompression of C4-5 and C6-7 was
done. Fidji cage 17X6.1X12 mm was inserted to
the C5-6 level. Fidji cages 16X4.5X12 mm were
inserted to C4-5 and C6-7 levels with Novabone.
Using Trinica cervical plate 3 level 66 mm
length was used to fuse C4-5-6-7 with 14 mm
length screws to each level.
Smooth postoperative recovery and some
improvement of the power of right side of the
body.
Comments
This case demonstrate that
extrusion in the presence of stenosis could
cause severe spinal cord injury such as
Brown-Sequard syndrome with almost complete
injury to the right half of the spinal cord as
in this case at the level of C5-6.
Inserting Fidji cages remove
load stress in the inserted screws, decreasing
the possibility of fracture or migration and the
lock mechanism in the Trinica plate decrease the
possibility of screw slipping.
Inserting cages with the
skull under traction 7 or more Kg will lessen
the elements of stenosis by slight stretching of
the ligaments.
The patient will need long
period for acceptable recovery.
Immediate
postoperative X-ray showing the constructs.
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 .
