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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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21-NOVEMBER-2011  NABEEL ABDEL-MUGHNY AL-ZGHAYER  53 YEARS  SPONDYLOLISTHESIS L5-S1 WITH BILATERAL ISTHMOLYSIS.

Anamnesis

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The patient came to the clinic 07-December-2010  complaining of LBP and left sciatica for 1 year. Exacerbation of left sciatica the last 3 months and walking with difficulty. The patient is a known diabetic and hypertensive for 4 years.

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On examination: SLRS was 80 degrees with pain in the right and 20 degrees with more pain in the left. There is weak dorsi and planterflexion left foot 4/5.

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The patient was sent for MRI of the lumbar spine, which was done 30-December-2010 showing spondylolisthesis L5-S1 II degree with bilateral isthmolysis, which were confirmed in the dynamic studies. The patient was advised to undergo surgery and he escaped for financial reasons for a year, then he came 18-November-2011 urging for surgery.

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Laminectomy of the flail L5 was done. Foraminotomy both S1 roots and left L5 root achieved. The left L5-S1 lateral mass was drilled out, so that the L5 root was seen running at the most left side of the field. Discectomy L5-S1 was performed from the left side and Zimmer TraXis PEEK OPTIMA 11x11x21 mm was inserted to the disc space with NovaBone putty, aided with bone harvested from the removed lamina. 2 monoaxial 6.5x45 mm screws were inserted to the L5 pedicle. 2 polyaxial 6.5x45 mm screws were inserted to the upper sacrum. The left screw was inserted and it was penetrating the contralateral cortex around 3-4 mm, which was accepted. 50 mm length bended rods were used and slight compression was applied at the left side. There was no space to put connector between the rods. The construct was aided with melted bone harvested from the lamina and lateral masses .

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Routine closure of the wound.  Smooth postoperative recovery with improvement of the power of  the left foot.


 

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 has unstable spondylolisthesis, which needs correction, decompression and fixation.

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It is worthy to put connector between the 2 rods, but there was no place to put it. Considering that the bone was marble-like solid and the screws were inserted bicortical with mild compression, it was seen that the connector is not important in this particular case.

 

 

 


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