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Dr. Ali Al-Bayyati and Dr. Munir Elias

 
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

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Multigen RF lesion generator .

 09-DECEMBER-2011  SONYA BUGHUS GASHRANIAN  47 YEARS  SPONDYLOLISTHESIS L4-5 WITH RECURRENT PLD L5-S1.

Anamnesis

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The patient came to the clinic 29-October-2011 complaining of LBP for 2 months with left sciatica and difficult standing and numbness of the II and III toes left foot.

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The patient underwent CABG and discectomy L5-S1 for right sciatica in 1996. MRI lumbar spine done 05-October-2011 showing spondylolisthesis L4-5  with complete segmental occlusion and recurrent PLD L5-S1.

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On examination, the patient has scoliotic stance and limping. SLRS was 90 degrees both sides without pain. There is weak dorsiflexion left foot -4/5 with hypalgesia left L5 and S1 root territories.

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Skeletonization of L4,5 and S1 with partial of L3 posterior bony structures down to the transverse processii both sides. Laminectomy of L5 and lower 3/4th of L4. Foraminotomy both S1 roots and left L5 root. Discectomy of L4-5 and L5-S1 with meticulous cleaning from the right side. Spineway TLIF (Swingo) 10x21 mm inserted at L4-5 level and 8x21 mm at L5-S1 level aided with NeveBone. Using transpedicular screws monoaxial 45x6 mm were inserted to the L4 level. To the L5 level monoaxial 45x6 mm was inserted to the left side and polyaxial 45x7 mm to the right side. To S1 level 2 polyaxial 40x6 mm screws were inserted with C-arm guidance. The rods were bended to accept lordotic curve of the area and fusion was achieved with slight compression and connector was applied at L5-S1 level. The bone harvested during laminectomy was milted and applied to the disc spaces and lateral to the rods.

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Routine closure of the wound with several water-tight layers. Smooth postoperative recovery with improvement of the power of  the left foot.


 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient had mobile spondylolisthesis at L4-5 causing severe segmental stenosis. She had also recurrent PLD L5-S1. Both problems must be corrected during surgery, for what decompression and fusion was performed to include  L4-5 and L5-S1 level.

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The stress point now is shifted to L3-4, which could trigger disc protrusion at this level.

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There was no isthmolysis, but the L4-5 facets were fractured in both sides. Pseudojoint was the end result of this fracture and overmobility. The bone was marble-like hard and insertion of the screws was force.


Postoperative reformatted check CT-scan showing the construct.


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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 .

 

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