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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
05-OCTOBER-2015 ABDELLATIF KAMEL AL-HAMAWI 64
YEARS LCS L2-3 DOWN TO L4-5, EXTRUDED DISC L2-3 WITH SPONDYLOLISTHESIS
L4-5.
Anamnesis
The patient came to the clinic 13-September-2015
complaining of right leg weakness with
pareasthesia for 2 years with left sciatica for
1 month.
On examination: the patient using crutch for 1
month, walking bended anterior with exaggerated
scoliotic stance. Cannot sleep supine or prone.
SLRS was 60 degrees both side with pain in the
left. There is hypalgesia left side 4 cm below
the umbilicus. There is weak planterflexion both
feet 4/5 and dorsiflexion right foot 4/5 and
left foot -4/5.
The patient was sent for investigations: Dorsal
spine MRI performed 15-September-2015 was
uneventful. Lumbar spine showed severe LCS L2-3,
3-4 and L4-5. There is extruded disc L2-3 with
spondylolisthesis L4-5. Dynamic studies
confirmed the mobility of the spondylolisthesis
L4-5.
Skeletonization of L1 down to
upper sacrum. 8 6.5x45 mm XIA 3 screws monoaxial
inserted to L2,3,4,5 and 2 screws 6.5x40 mm to
L1 level. Decompressive laminectomy L2,3,4 and
partial of L1 and L5. Extended foraminotomy of
the left L4 root was performed. There is CSF
leak from this area. The screw made tear to the
lateral wall of the axilla of the root. Using 4
zero nylon the tear was closed water-tightly.
Check for CSF leak was negative. The same root
was exposed to PRF using MultiGen using 2 Hz 20
msec duration of pulse and 42 Celsius for 240
sec. The root hanging free. No extruded disc is
seen. The harvested bone was milted and applied
lateral to the rods, which were corrected with
distraction of the left side to correct the
scoliotic deformity. Multiaxial cross connector
was applied. All stages were done with C-arm. Routine closure of the
wound.
Smooth postoperative recovery. The patient was
sent to the ward.
MultiGen
Comments
The patient has several problems, which
need correction.
The dural tear was caused by the screw
thread which was seen in the medial border of the pedicle.
The screw was lift in place and the root was stitched and
logically no compression was seen at this area.
This is the 10 case using the PRF mode to
the most involved root. Time will tell the result.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
fixation is the most accurate system in the market. The microdrive and
its sensor gives feed back about the localization.
Inomed MER system
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
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 .
