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Dr. Ali Al-Bayyati and Dr. Munir Elias

 
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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17-DECEMBER-2011  NURY ASHOUR AL-TREKY  57 YEARS  RESIDUAL AFTER POSTERIOR DECOMPRESSION FOR CERVICAL CANAL STENOSIS WITH PCD C5-6, C6-7.

Anamnesis

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The patient came to the clinic 21-November-2011 complaining of difficult walking with neck pain. The patient was operated 2 years ago for cervical canal stenosis by posterior decompression. The patient did not noticed any improvement after surgery. The patient condition continued to deteriorate and he is walking with spastic pattern. The patient has arterial hypertension for three years and he is complaining of headache since that time.  

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On examination, the patient has shuffling gait  and limping having weak grip left hand 4/5 , extension 3/5 biceps brachii right 4/5 and triceps 3/5. There is weak dorsiflexion right foot -4/5, left foot -4/5 and planterflexion left foot 4/5 with left sided sciatica. Hoffmann was positive in the right and Babinski both sides.

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The patient was sent for investigations, which revealed pontine old infarction and posterior decompression C4-5-6 with mild stenosis C6-7 and PCD C5-6, 6-7 left side with malacia of the spinal cord at these levels.

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It was explained to the patient that he has multiple problems, that anterior decompression with fusion could help him, only if the anterior spinal artery irritation playing a role in his condition and his deterioration. The patient insisted for surgery.

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Discectomy of C5-6, C6-7 with osteophytectomy was done. Fidji PEEK with NovaBone 12x15x6.1 mm was inserted to C5-6, and 12x15x6.9 mm to C6-7 level. Zimmer cervical plate 2 level 40 mm length with 2 fixed 16 mm screws to C6 and 4 variable 16 mm screws to C5 and C7 were used to fuse C5-6 and C7.

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Routine closure of the wound. Smooth postoperative recovery with improvement of the power of four limbs.



Reformatted postoperative CT-scan showing the construct.

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 had posterior decompression of the cervical stenosis. The presence of pontine old infarction and malacia of the spinal cord, make it difficult to estimate the deleterious effect of the disc extrusions and the role of the anterior spinal artery syndrome in this case.

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The patient was urging for surgery, and it was explained to him that the expected recovery is doubtful, but he insisted.

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The patient showed dramatic improvement after surgery, that he could predict the improvement, for what, he insisted for surgery.

 

 

 

 

 

 


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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 .

 

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