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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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Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator .

13-DECEMBER-2010  KALIMEH ABDEL-KAREEM HABIB  58 YEARS  SPONDYLOLISTHESIS L4-5 WITH SEVERE SECONDARY STENOSIS.

Anamnesis

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The patient came to the clinic 09-December-2010 complaining of LBP with bilateral sciatica, more the right for 10 years, progressing with time. MRI lumbar spine performed 26-May-2010 reported as having LCS L4-5 and L5-S1. She was operated elsewhere and she did not improve after surgery. MRI lumbar spine repeated after surgery 26-June-2010 showed decompression of L2-3, 3-4 with the L4-5 and L5-S1 still the same.

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On examination: The patient  is in pain, limping with exaggerated scoliotic stance. The patient cannot walk more than 20 meters. here is weak dorsi and planterflexion both feet -4/5 with hypalgesia below the knees both legs. The patient was also complaining of bilateral CTS, more the right.

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The patient was sent for investigations, and MRI performed 09-December-2010 showing spondylolisthesis L4-5 II degree by Meyerding.  and severe LCS at this level with bulge L5-S1. EMG confirmed the presence of severe compression both median nerves more at the right wrist.

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Decompressive laminectomy of L4and L5. Foraminotomy both L5 roots. The disc space was cleaned from both sides more from the left. The spinous process and lateral masses of L4-5 were mobile from the start of the operation.  TILF Leopard  7 mm height was inserted to the disc space L4-5 from the left, aided with Novabone. The space was aided with her own bone harvested from the spinous processii. Transpedicular polyaxial screws 5.5 mm X35 mm was applied to the L4 pedicles. Transpedicular screws polyaxial 6.5 mm X 40 mm were applied to the L5 pedicles. All these steps were guided with image-intensifier and checked by IOM ISIS HighLine with transpedicular protocol. The roots were responding to stimulation around 3-4 mA. The screws were not responding to currents even with more than 20 mA, which means that there is no contact between the screws and running roots. Two bended rods 45 mm length were inserted and fixation achieved with slight compression. A transverse connector  52 mm was applied to stabilize the rods. MTF Cancellous bone chips 15 cc were inserted lateral to the rods. 

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Routine closure of the wound. Smooth postoperative recovery.


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 was operated initially for the wrong diagnosis with the wrong level.

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The best option for this case is trilateral fixation using the TILF and transpedicular screws, after achieving good neural decompression.

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IOM with dedicated transpedicular set designed by Inomed is a mandatory part of surgery to avoid neural injury complications.

 

 

 

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