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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
02-DECEMBER-2011 WALEED MUHAMED KHAYATAH 71 YEARS
SEVERE LUMBAR CANAL STENOSIS L2-3, 3-4 AND L4-5.
patient is a Syrian doctor, known diabetic for 5
years with arterial hypertension with history of
CABG done 10 years ago came to the clinic
complaining of LBP for 4 years with bilateral sciatica
with inability to walk more than 100 meters with
numbness both feet. The patient claiming that
his condition is deteriorating. Cervical MRI
22-December-2008 showing severe cervical
stenosis C4-5, 5-6 and C6-7 with malacia of the
spinal cord. MRI lumbar spine performed
09-May-2010 showing spondylolisthesis L4-5 with
examination, at that time, he had shuffling gait
with exaggerated scoliotic stance. He had weak
grip right hand and extension both hands and
triceps both arms -4/5. He had Hoffmann sign
more pronounced in the right side. The muscles
both legs were weak -4/5 more weak in the right
side. Babinski was positive in the right side
and there was diabetic neuropathy both feet.
SLRS was 65 degrees both sides. The patient was
sent for new MRI of the cervical, lumbar with
LSS X-ray dynamic study. The investigations done
02-June-2011 confirming severe stenosis C4-5,
5-6 and C6-7 and stenosis at L3-4, L4-5. The
patient was advised to undergo surgery for CCS ,
but he escaped.
patient then came 01-December-2011 flying from
Syria, claiming that he was doing well, but
yesterday, he got sudden onset LBP with
inability to stand and walk. He performed the
posterior cervical decompression in Syria in
examination, the power of both upper limbs was
5/5, but SLRS was 5 degrees both sides due to
weakness. All the muscles both lower limbs were
weak and the dorsiflexion both feet was 3/5.
There was analgesia both L4 roots with
preservation of sensation of both feet and
below. There was no micturition or defecation
New MRI of
the dorsal and lumbar spine were performed ,
showing complete stenosis at L3-4, L4-5 and mild
one at L2-3.
Skeletonization of L2-3-4-5 spinous processii.
The lamina of L4 was checked for unstable
elements or overmobility. All data were
negative, nor isthmolysis was present.
Decompressive laminectomy of L3,4 and partial of
L2 and L5. The epidural fat was missing at the
L2-3, 3-4 and L4-5 levels. Foraminotomy of
L3,4,5 roots was achieved in both sides. Special
attention was paid to seek the sudden onset of
his LBP with severe weakness. It was found that,
there is hemorrhage intraligmental in the left
side of the L3-4 facet, triggered with the
presence of huge vein. The hematoma was 24-36
hours age. All the compressive elements were
removed. At all stages of surgery, check for
instability was performed at L4-5 level, which
was proved to be negative.
recovery with improvement of the power of
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
The patient had cervical canal stenosis with
lumbar canal stenosis, which are both
progressive in course. The cervical
decompression must take precedence, which was
The cause of sudden deterioration, was not
spondylolisthesis of L4-5, but the hemorrhage in
the L3-4 level which took place
intraligamentally and was the cause of his
In retrospective analysis and interrogation, the
patient felt down 2 days ago to the left side
and chest X-ray showed fracture of the 9th rib
left side without hemo or pneumothorax.
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 .