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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28-DECEMBER-2008 ZAKARIYA AHMAD ODEH 59 YEARS
POST-TRAUMATIC STENOSIS AT D11-12 WITH PROGRESSIVE PARAPARESIS.
The patient came to the
clinic 23-December-2008 complaining of difficult
walking due to weak both lower limbs more the
right for two years and numbness both
lower limbs with progressive course.
The patient suffered RTA 3
years ago with wedge fracture of D12. The
patient receiving Xatral for prostatic
hypertrophy for the last 2 months. The patient
has Polio of the right lower limb since
MRI of the lumbar spine with
MRMyelography was performed 17-December-2008
showing the wedging of D12 and severe stenosis
at this level with malacia of the spinal cord at
On examination: the patient
has exaggerated scoliotic stance. SLRS
was 20 degrees right side with bilateral
sciatica. He had weak dorsi
and planterflexion both feet 4/5 with weak right
quadriceps muscle 3/5 and adductors of the knees
4/5 and abductors of the right knee 3/5 and left
knee 4/5.He has hypalgesia both lower limbs
below the knees with signs of cauda equina
syndrome more pronounced in the right side.
Babinski was positive both sides with clonus
Using image-intensifier, theD11-12 level was identified and
decompressive laminectomy of D11 and D12 was
performed. The spinous processi of D11 and D12
were destroyed and replaced by cartilaginous
structures, but the lamina were stable. After
decompression the bony alignments were checked
another time for stability. There was no
epidural fat at the exposed dural sheath. Routine closure of the wound with
water-tight multilayer stitching.
Smooth postoperative recovery
and the power of the left leg normalized with
slight improvement of the power of the right
The patient suffered RTA 3
years ago and he was not diagnosed at that time.
The spinous processi were completely destroyed,
which was found during surgery. The wedged old
fracture was stable.
The malacia of the spinal
cord could be due to the direct injury to the
spine, or due to the repetitive microtrauma with
The progressive course of
deterioration mostly related with callus
formation around the facet joints, which caused
secondary canal stenosis with escalation of the
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