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Multigen RF lesion generator .

27-MARCH-2023  AZIZEH HASAN ABU-SIYAM  60 YEARS  SEVERE LUMBAR CANAL STENOSIS L3-4, 4-5 WITH BULGE L3-4 MORE TO RIGHT.

 

Anamnesis

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The patient came to the clinic 16-March-2023 with LBP and right sciatica for 6 months and difficult walking and numbness right foot. MRI done 20-February-2023 showing severe lumbar canal stenosis L4-5 and L3-4. CRP was 4.3 mg/dL, ESR was 59 mm/h and RF 29.2 IU/ml. Dynamic studies showed mild spondylolisthesis L3-4.

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On examination, the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 80 degrees both sides with pain more in the right side. There is weak dorsiflexion right foot 4/5.

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The patient was sent for investigations and MRI lumbar spine showed severe lumbar canal stenosis L3-4 and L4-5 with bulge L3-4 more to the right, dynamic studies ruled out overmobility. CT-scan of L1-S1 with ORS Visual was uneventful.  Lab investigations repeated 25-March-2023 showed still high ESR 64 mm/h.

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Decompressive laminectomy L4 and L5 with foraminotomy both L4 and L5 roots with inspection of the annulus fibrosis of L3-4. It was decided not to violate the disc because there is no extrusion. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Prednisolone was irrigated around the translucent epidural sac and Xylocain with Marcaine was injected around the incision. Routine closure of the wound. The power of the right foot normalized. She was sent to the ward.

FOLLOW UP

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Too early now.

Comments  

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The sooner the decompression, the better the outcome in progressive severe stenosis.

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

Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014

LooksCam II in the run.
LooksCam II Xenosys in the run  starting from  14-March-2021 with SheerVision TTL x4 magnification. 

 
Cios-Spin flat panel in the run.

 

 


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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