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
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23-JULY-2011 ASIA MUHAMED JASEM 57 YEARS
SPONDYLOLISTHESIS L3-4, L2-3 AND LEFT LATERAL RECESS L4-5.
patient is an Iraqi citizen came to the clinic
17-July-2011 complaining of LBP for 14 years
with exacerbation of the left sciatica the last
year with inability to walk more than 100
spine done 16-July-2011 showing lumbar canal
stenosis L2-3 and L3-4 with Lumbar X-rays
showing severe scoliosis at L2 level.
examination: the patient a known diabetic in
insulin for 11 years, was limping with
scoliotic stance. SLRS was 85 degrees in the
left with pain. She had OA left knee with with
effusion. She was also complaining of neck pain
with weak both upper limbs and bilateral severe
carpal tunnel syndrome.
patient was sent for further investigations,
including the dynamic studies of the lumbar
spine, which confirmed the presence of unstable
spondylolisthesis L3-4 and to minimal degree the
L2-3 and left L4-5 lateral recess syndrome.
Skeletonization of L2-3-4-5
was done down to the lateral processi. 2 Depuy
Expedium ployaxial screws 7x40 mm were inserted
to the L2 pedicles. 6 monoaxial screws 6x40 mm
were inserted to L3,4 and L5 pedicles. Complete
laminectomy L3 and partial of L2 and L4 was
performed. Left L5 root foraminotomy was done to
check the root during intended traction.
Discectomy L3-4 was performed from the left and
the disc space was filled with her bone
harvested during laminectomy. TILF 8x28 mm was
inserted to the L3-4 disc space. 2 rods bended
were inserted first from the left side with
slight compression at L3-4 level and distraction
at other levels. During the insertion of the
other rod from the right side, it was noted that
during forced cooptation of the lower screw,
this later was shifted upward, for what, it was
needed to remove this monoaxial screw and insert
another polyaxial 7x40 mm, after what it was
possible to make fusion. A crosslink was
inserted at the level of L3-4. The bone graft
was added to the construct.
closure of the wound. Smooth postoperative
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The patient has multiple spine problems, which
need attention and subsequent correction.
The patient had severe scoliotic curves that
needs compression at parts and distraction at
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 .