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
The patient came to the clinic 08-July-2000. She is an Iraqi lady
was complaining of LBP for 16 years. She had exacerbation of her
left sciatica and left shoulder pain. X-rays performed 1999
showing osteoporosis with spondylolisthesis L4-5 I degree by
Meyerding scale. She was complaining of numbness of her II-IV toes
left foot. She could walk more than 1 Km at that time. MRI performed
10-July-2000 showed secondary stenosis at L4-5 and she was
advised for conservative treatment for pain and osteoporosis.
She was seen 12 times during the following 6 years with ups and
downs, but acceptable neurological condition.
The last time, the
patient deteriorated and she could not ambulate and bilateral
sciatica with almost drop both feet. MRI performed 14-February-2006
showing escalation of her spondylolisthesis at L4-5 and severe LCS
L4-5 , for what she was advised to undergo surgery.
Laminectomy of L4 and 5 was done with bilateral foraminotomy both
L5 roots was done. Inspection of the disc surface was negative
except for the gap between the L4 and L5 bodies. Using Stryker
instrumentation, transpedicular screws were applied , the L3 pedicle
was used with polyaxial screws and the L5 pedicles with rigid
screws. Distraction was applied about 20 mm reduction. A bridge was
inserted between the rods to have more secured stability of the
construct. All the operation was guided with the aid of image
intensifier. The removed laminae were crushed and used as bone graft
lateral to the construct between the transverse processii of L3 and
L5 both sides. Routine closure of the wound.
Postoperative check X-ray of the construct done 12-March-2006