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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04-MAY-2013 AFIFEH ALI ABDEL-HALEEM 67 YEARS
SPONDYLOLISTHESIS L3-4, L4-5 WITH SEVERE SEGMENTAL STENOSIS WITH
EXTRUDED DISC L4-5.
The patient came
to the clinic 24-April-2013 complaining of LBP
for 15 years with numbness both feet and
hands for 10 years. The patient is a known
hypertensive in medications for 15 years.
Cardiocath done 2011 was uneventful. In
warfarin. lanoxine, aldactone and concor.
MRI of lumbar
spine done 24-October-2010 showing old fracture
of D12 with spondylolisthesis L4-5 and extruded
disc L4-5 with central upward migration.
On examination: The patient is limping with
exaggerated scoliotic stance.
There is ganglion dorsal aspect of the right
wrist. Edema both forelegs. Pain when turning
the head to all directions. SLRS was
20 degrees right side with pain and 70 degrees in the left
with less pain. There is weak dorsiflexion right foot
The patient was sent for new investigations and
MRI lumbar spine performed 27-April-2013 showing
spondylolisthesis L3-4, L4-5 with severe
segmental stenosis with extruded disc L4-5. The
old fracture of D12 is the same. There are small
bulge disc of the cervical spine. Treatment of
gout was started.
laminectomy L4, upper half L5 and Lower 2/3 of
L3 was done with foraminotomy both L5 roots.
Discectomy L4-5 with cleaning of the space with
insertion of Novel TL TLIF cage 10x15x25 mm from
the right side with Vitoss bone graft to both
sides. Using Isobar TTL Module In, 6 polyaxial
65x45 mm screws, transpedicular screw fixation
was done to L3,4 and L5 with bended rods 73 mm
length and cross connector 80 mm length. The
mentioned bone graft was inserted lateral to the
Routine closure of the wound.
Smooth postoperative recovery. The patient had
atrial fibrillation during surgery and the
patient was sedated accordingly.
The patient several spine problems, which need
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