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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01-APRIL-2008 KHALED FAT'HI ABU-NUWWAS 48 YEARS
SUBLUXATION OF C3-4 AND C4-5 WITH DEFORMITY OF C5 AND C6 WITH MALACIA OF THE
CERVICAL SPINAL CORD.
The patient came to the
clinic 24-February-2008 complaining of neck pain
for 2 years with numbness four limbs with
inability to walk for 1 week. Cervical X-ray
done 1994 showed dislocated C4-5.
The patient was operated by
me 1995, 1997 and 2000 for PLD L4-5.
On examination: the patient
had Lhremitte sign when extending the neck
upward. Hoffmann was positive both sides with
weak both deltoids biceps brachii and
triceps 4/5. The grip right hand was 3/5 and
grip left and extension both hands were 2/5.
There was generalized weak all muscles lower
limbs 3/5. Analgesia of the neck and right side
of the body and left arm and left lower limb
below the inguinal region. Spastic both lower
limbs with exaggerated deep reflexes and
Babinski positive both sides. The patient was
sent for investigations.
MRI cervical spine performed
01-March-2008 showed dislocation of C3-4 and to
lesser degree of C4-5 and deformity of C5 and C6
with malacia of the cervical spinal cord at C3-4
level. MRI of the brain
The patient is diabetic for 6
months in glunil 5 mg per day, hypoten 50 mg
once daily, Low-lip and angiotec 10 mg once
daily and in
baby aspirin. He underwent stinting for coronary
artery disease 2002.
Discectomy of C3-4, C4-5 and
C5-6 was performed. Partial coporectomy of C5
and upper third of C6 was done, using the
high-speed drill. Preoperatively, it was decided
to use the fibular graft, but during surgery,
tricortical iliac bone graft was sufficient. It
was harvested from the right. The graft was
remolded to accept the bony tunnel and drilling
was performed, so that with traction of 8-10 Kg
was sufficient to hold the construct with the
aid of impactor.
Trying different miniplates,
it was decided to use 3 level fusion miniplate
with 2 screws in the C3 body and 2 screws in C4
body and 2 screws in C7 body. The 2 screws at C4
were forced so that, they could regain some
reduction of the subluxation. All measures were
applied to regain normal cervical curvature of
the spinal column. Image-intensifier was used at
steps of the operation.
Routine closure of the wound
with smooth postoperative recovery.
Considerable improvement of the power
of the four limbs.
Anterior approach to cervical
spine is mandatory, when the correction is
impossible from posterior.
All the compressive elements
must be eliminated during surgery, even if
coporectomy is needed. During Coporectomy a
ridge must be left underneath to prevent
slipping of the graft.
Subluxation, compression, and
mechanical factors must be resolved during
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