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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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29-FEBRUARY-2012  AYISHAH HUSSEIN MUHAMED  65 YEARS  SEVERE DORSAL CANAL STENOSIS D3-D6 AND D9-D11 WITH MALACIA OF THE SPINAL CORD AT THESE LEVELS- SECOND STAGE.

Anamnesis

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The patient is a Libyan citizen came to the clinic 08-February-2012 complaining of difficult walking after surgical intervention performed in Libya 15-January-2009. Fixation of L4-5 and S1 was performed at that time. The patient continued to deteriorate and MRI cervical spine performed 06-October-2011 showing small disc C6-7 , but dorsal MRI showing severe stenosis of the canal at D4-5, D5-6, D10-11 and D11-12.

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On examination, the patient cannot walk with severe atrophy of both lower limbs. There is profound weak both lower limbs 3/5 of all muscles. Babinski sign was positive both sides, but there was no clonus. No sensory deficit.

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The patient was sent for further evaluation. MRI of the brain performed 20-February-2012 showing scattered lacunar infarctions both cerebral hemispheres. MRI dorsal spine performed 13-February-2012 showing severe stenosis at the above mentioned levels with malacia of the spinal cord at these levels. The stenotic elements were due to ligamentum flavum hypertrophy.

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The patient was operated as first stage 4 days ago. She was given 2 units blood and Hb after surgery was 8.0 and became 13.8 after transfusion.

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Laminectomy of D9-10-11 was performed with drilling of the most adjacent bone structures to the dura. The compressed bony parts were not only adherent to the dura, but the dura was missing at several areas.  All the bony and soft tissues elements were removed. Some areas of calcified dura was left in place. There a lot of dural defects in the exposed field and it is impossible to repair them. DuraGen Plus Integra 2.5 cm x 7.5 cm was applied to the area. Another layer was applied over the first one. Water-tight closure of the wound.

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Routine closure of the wound. Smooth postoperative recovery with improvement of the power of both legs.


 

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 was operated 4 days ago and decompression of the upper dorsal stenosis was performed. The patient improved, but it is worthy to eliminate all the stenotic elements.

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The compression was severe enough to fade out the dural layer in certain points. Decompression was impossible without creating the dural defects. Surgical repair of the dural defects is impossible. DuraGen application is the only available solution.


Back Up!

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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