www.neurosurgery.tv 
   

neurophysiology.ws
neurosurgery.tv
e-neuroradiology.com
onconeurosurgery.com
craniopharyngiomas.com
pituitaryadenoma.net
meningiomas.org
neuro.science

Surgical group is like a football team.

 
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

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
cns-online.com
cns.surgery
cns.today
e-neurosurgery.com
neurosurgery.ag
neurosurgery.bz
neurosurgery.co
neurosurgery.cz
neurosurgery.gallery
neurosurgeryvideo.gallery
neurosurgicalvideo.gallery
neurosurgery.guru
neurosurgery.me
neurosurgery.mx
neurosurgery.photos
neurosurgery.tips
neurosurgery.tw
neurosurgeryspine.org
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.com
neurosurgicalencyclopedia.net
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
craniopharyngiomas.net
ependymomas.com
ependymomas.net
glioma.co
gliomas.info
meningiomas.info
meningiomas.org
neurooncology.me
neurooncology.tv
neurooncology.ws
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com
pituitaryadenoma.net
schwannomas.com

Neuroanatomical Sites
diencephalon.org
humanneuroanatomy.com
medullaoblongata.info
mesencephalon.org
microneuroanatomy.com

Neuroanesthesia Sites
neuroanesthesia.info

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com
neurophysiology.ws

Neuroradiological Sites
neuroradiology.ws

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com
vascularneurosurgery.net

Personal Sites
cns.clinic
cnsclinic.org
munirelias.com

Spine Surgery Sites
spine.surgery
spinesurgeries.org
spondylolisthesis.info
paraplegia.ws

Stem Cell Therapy Site
neurostemcell.com


Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

17-APRIL-2010  ELENA NICOLAY ZIKOVA  48 YEARS  PCD C5-6 CENTRAL AND C6-7 WITH RIGHT FORAMINAL OCCLUSION.

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


Postoperative Check up showing good alignment of the lower device and shift to the left of the upper device.

Anamnesis

bullet

The patient came to the clinic 02-February-2010 complaining of neck and right upper limb pain for 1 year. The condition is progressing and she progressed numbness all fingers right hand.

bullet

MRI cervical spine performed 19-December-2009 showed PCD C5-6 central and C6-7 more to the right.

bullet

On examination: the patient has weak grip and extension right hand 4/5 with right triceps muscle 3/5. There is limitation and pain when looking to the right and down and swaying the head to the left.

bullet

The patient progressed further deterioration and was advised to repeat MRI of the cervical spine, which was done 14-April-2010 showing complete occlusion of the right C6-7 foramen.

bullet

Using image-intensifier, discectomy of both C5-6, C6-7 was performed with removal of the extrusion in the right C6-7 foramen. Prestige LP cervical system Medtronic was inserted to both levels 5X16 mm dimension for C5-6 and 6X16 mm for C6-7 disc space. Check image-intensifier was repeated at all stages of the surgery and implants insertion.

bullet

Routine closure of the wound.

bullet

Smooth postoperative recovery, with full recovery of the power of the right upper limb.


Comments

bullet

The patient was essentially operated for the extruded disc C6-7 with complete occlusion of the right foramen.

bullet

The extruded central disc C5-6 was causing stenosis to the spinal cord. Taking the advantage of surgical intervention in the same area this stenosis was resolved surgically to prevent future escalation of the stenosis .

bullet

The best option is to keep the maximum dynamico-physiological functions of the violated levels. This can be achieved nowadays by applying the cervical disc system such as Prestige LP Medtronic, even for 2 levels.

bullet

Applying these rules, the late postoperative stenosis or disc extrusion of the above and down levels will be lowered considerably, by minimizing the stress which will be transferred to these mentioned levels.

bullet

It was noticed, that during insertion of the lower device, the previously inserted device at C5-6 slipped for 2 mm, for what it was impacted another time. After that the lower device slipped for 1 mm and it was reimpacted accordingly. This fact draw our alertness about possible slipping of the constructs. So as, to minimize this possibility, it will be recommended to keep the patient in collar for at least 3 months and to avoid strenuous activities.

bullet

So as to have perfect midline alignment of the device special instrumentation must be added to know that the device will be in absolute precision in the midline, before proceeding with the other steps of the operation. Anatomical markers are not sufficient and image-intensifier can be misleading.

bullet

New Brands of this construct must be added with slight curvature in the AP plane so as to have more perfect alignment of the upper and lower bodies (notice that the upper system is stuck with bone at C6, but  it is for 1 mm protruding at the lower edge of C5.


Back Up!

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 .

     WELCOME TO AL-SHMAISANI HOSPITAL

  

[2010] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved