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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08-APRIL-2013 FATMEH ALI ABDALLAH 64 YEARS
SEVERE CERVICAL STENOSIS AT C5-6 LEVEL WITH MALACIA OF THE SPINAL
The patient came
to the clinic 03-April-2013 complaining of LBP
with left sciatica. She performed bilateral
carpal tunnel release 7 days ago with resection
of basal cell carcinoma of the nose. The patient
underwent total knee replacement 2003 and 2005.
She underwent fixation of the spine with
transpedicular screws of L3, L4 and L5 after
what her condition deteriorated due to wrong
screw placement of the left lower screw. The
patient is using walker to ambulate. MRI of the
lumbar spine done 17-March-2013 showing severe
stenosis with spondylolisthesis of L4-5. The
patient is a known diabetic for 35 years.
On examination: The patient is limping using
walker and it is difficult to evaluate the scoliotic stance.
Hoffman sign was positive both sides. SLRS was
45 degrees right side and 25 degrees in the left
with pain. Babinski was positive both sides. Weak
foot -4/5 and right foot 4/5 with weak
planterflexion left foot 4/5. There is diabetic
neuropathy both feet with decreased sensation
below the ankle joints.
The patient was sent for more
investigations. MRI of the brain and dorsal
spine were uneventful. MRI of the cervical spine showed
severe segmental stenosis C5-6 with malacia of
the spinal cord at this level.
It was explained to the
patient, that surgical elimination of the severe
cervical stenosis taking precedence over the
screws problems in the lower back.
Decompressive laminectomy of
C4,5,6 and upper third of C7. During drilling a
pin-point tear was noted at the left corner of
C4. It was repaired with 4 zero nylon. The dura
was very thin and there was no epidural fat with
dura adherent to the connective tissues more to
the left side. Check for CSF leak was negative.
Routine closure of the wound.
Smooth postoperative recovery. The power
of both feet became more strong.
The patient has several problems and the
cervical stenosis taking precedence over others.
It must be corrected first.
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