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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.fr

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17-OCTOBER-2012  AWWAD MAHMOUD AWWAD  18 YEARS  SLIPPED EPIPHYSIS L3-4 WITH UPWARD MIGRATION.

 

Anamnesis

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The patient came to the clinic 17-October-2012 in wheelchair wit severe agonizing LBP and bilateral sciatica for 1 week and inability to walk or stand the last 2 days. The patient is crying and cannot find a position to make him feel any relief.

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MRI lumbar spine done 17-October-2012 showing huge extrusion of L3-4 with upward migration.

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On examination: the patient cannot stand for scoliotic evaluation and it was hard to examine him. SLRS was 0 degree in both sides with complete drop both feet with planterflexion both feet 0/5 and analgesia of both lower limbs below the knees. Defecation and micturition telling that are normal. The AJs are absent both sides.

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Using C-arm, the L3-4 level was identified and 3/4 laminectomy of L3 was done with bilateral flavotomy and bilateral foraminotomy of L4 roots. Slipped epiphysis was noted and the extruded material including the slipped epiphysis were removed from both sides and cleaning of L3-4 disc space was done from both sides, until the roots and the dura were lax and free.

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Routine closure of the wound. Smooth postoperative recovery with disappearance of the sciatica and some improvement of the planterflexion both feet 3/4 and dorsiflexion left foot 3/4.

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 is young and slipped epiphysis is usually noted in the young age starting from 10 years and to 18 years of age.

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The patient will need long-term physiotherapy to recover his neurologic deficit.

Leica HM500

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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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[2012] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved