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 me
19-October-2005 complaining of LBP for 3 years with continuous
numbness of the right foot and left sciatica. She is a known
rheumatoid patient. MRI of the brain and lumbar spine done
27-January-2003 showed spondylolisthesis L5-S1 II-III degree. On
examination, she had weak dorsiflexion both feet with hypalgesia
both L5 roots territories. New MRI lumbar spine requested.
Considering that her condition is deteriorating and she cannot walk
more than 5-10 meters, it was decided to operate her.
Skeletonization of L4, L5 and upper sacrum was performed and the
flail L5 lamina was removed, exposing during that both L5 and S1
roots. It was impossible to reach the pedicle of L5 body without
jeopardizing the bony alignment, for what, transpedicular polyaxial
version was applied between L4 and the upper sacrum. After traction,
it was possible to see the destroyed L5 pedicle. For further
fixation a bridge was applied to achieve more stable construct. The
operation was smooth and took only 2 hours.
1. Trying to keep the L5 lamina
and perform reduction and fixation by transpedicular screws, can
make the flail lamina stable, but it is a bad idea, because the
surgeon cannot have a good idea, what happening under these
preserved bony structures.
2. Removing the flail lamina make
the operation more safe and speedy and can catch under vision what
going on , during the insertion of the screws. For example, the
walls of the pedicles can crack and the lousy fragments can cause
radicular pain to the patient.
3. Reduction is more safe, when
the flail lamina is removed. In this case, without doing this, it
was impossible to gain the intended goal of surgery.