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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

 

16-SEPTEMBER-2006  WALEED MUHAMED ABDEL-HAMEED  35 YEARS  UNSTABLE FIXATION FOR SPONDYLOLISTHESIS L4-5.

The patient came to the clinic 12-July-2006 in agonizing LBP with bilateral sciatica and inability to walk without help. The patient was operated elsewhere 3 times for spondylolisthesis L4-5. All the operations were performed 2004, and up to now he is suffering from this condition. On examination: SLRS was 5 degrees in the right and 10 degrees in the left. He had weak planter and dorsiflexion both feet with almost drop right foot. The right foot is swollen and he is under treatment for DVT.

The patient was sent for MRI, CT-scan  and LSX-ray. The transpedicular screws inserted between L4 and L5 . Actually, there were no pedicles of L4 body. The construct seem to be acceptable, but the condition mandate exploration to resolve his problem.

After exposure of the parts of the construct outside the bony elements, check for instability was positive. The upper right transpedicular screw was movable and the area had overmobility. The lower screws were acceptable.  The upper screws of Stryker brand were removed and another new transpedicular polyaxial type were inserted to the L3 pedicles. A longer rods were used and distraction for 20 mm both sides was achieved. Bridge was inserted between the rods to achieve more stable design.

Postoperative recovery was unexpectedly dramatic. The power of both feet became full with disappearance of bilateral sciatica.

Comments:

1. Never use the pathologically involved pedicle for fixation. Insert the screws to above laying normal pedicles and apply traction from there. When the patient has isthmolysis and abnormal pedicle alignment, jump to the normal anatomy and use that part to achieve your mission.

Postoperative LSS X-ray and CT-scan showing the good alignment of the construct.


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved