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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26-JUNE-2008 ABDEL-RAHMAN SBETAN SHALABI 69 YEARS
LCS L3-4, L4-5 WITH ANEURYSM OF THE AORTA BELOW THE RENAL ARTERIES.
The patient came to the
Emergency of Al-Shmaisani hospital 23-June-2008
and then to the clinic 24-June-2008 with LBP and
left sciatica for 3 years with progressive
intermittent claudication. The patient the last
months cannot walk more than 100 meter.
MRI of the lumbar spine done
32-June-2008 showing lumbar canal stenosis L4-5
with lesser degree of L3-4.
On examination: the patient
is complaining of tingling sensation of the left
loin and both lower limbs. There is weak
dorsiflexion both feet 4/5 and planterflexion
left foot 4/5. The patient during workup showed
a giant wide based aneurysm of the aorta below
the renal arteries and without
Leriche syndrome. There is stenosis of the
left renal artery and the patient underwent
stinting for coronary arteries several years
Considering that the patient
had aneurysm of the aorta, special attention was
paid for his positioning to prevent compression
of the abdominal cavity and femoral arteries.
Laminectomy of L4 and partial
of L3 and L5 was performed. Foraminotomy of both
L5 roots was performed. It was noticeable, that
the patient had soft tissue compressing elements
arising from the left L4-5 facet joint, which
was subsequently decompressed. The presenting
epidural remnants were preserved, but it was
missing at 2 levels due to the severe
compression. Routine closure of the wound.
Smooth postoperative recovery
and the power of both lower limbs improved.
The patient had intermittent
claudication and the two major causative factors
are Leriche syndrome and lumbar canal stenosis.
The patient had aneurysm of the aorta below the
renal arteries, but the flow was patent. The
patient had severe lumbar canal stenosis, which
was the cause of his complains in this case.
The presence of such aneurysm
requires special attention to prevent rupture
during surgery. The positioning with high
intra-abdominal pressure could lead to rupture
and all measures must be done to prevent such as
these triggering factors.
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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 .