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 .
26-AUGUST-2014 HANAN HASAN AMRO 50 YEARS
RESIDUAL AFTER TRANSPEDICULAR FIXATION L5-S1 WITH RIGHT SCIATICA.
Anamnesis
The patient came to the clinic 16-August-2014
complaining of right sciatica for 4 months. She
was operated 3 years ago for spondylolisthesis
in Saudi Arabia 3 years ago, after what the
patient telling that she improved for 60%
approximately, but deteriorated the last 4
months.
On examination; the patient is in agonizing
pain, limping with exaggerated scoliotic stance.
SLRS was 40 degrees in the right with pain and
70 degrees with less pain. There is weak
dorsiflexion right foot -3/5 and planterflexion
same foot 4/5. There is hypalgesia right S1 root
territory.
The patient was sent for new MRI of the lumbar
spine with dynamic studies and CT-scan of the
operated area and lab investigations. The
CT-scan with reconstruction using ORS Visual
showed the right upper screw touching the root.
It was decided to explore the the site of
surgery and resolve all her problems.
The old incision refreshed and the four screws
exposed. The right rod was removed. Using Inomed
ISIS transpedicular screw protocol, the right
lower screw and both left screws did not gave
EMG response even with 15 mA DNS stimulation.
The right upper screw gave response even with 8
mA DNS stimulation. The construct is of Expedium
brand. The type of the screw is polyaxial. It
was removed and inspection of the screw cavity
with feeler confirmed that it is located in the
soft tissues. As seen in the figure below, the
screw was inserted vertical to the sagittal plan
and it was media at the level of the pedicle and
outside the body of the L5. Foraminotomy right
L5 and S1 roots. They were responding even
with 1-2 mA DNS stimulation. Using Stryker XIA 3
system a new polyaxial screw 6.5x50 mm was
inserted from near upper point and directed
medially. All the screws now not responding even
with 15 mA DNS stimulation. MAC cross connector
42 mm was applied to gain more stability of the
construct. The harvested bone melt and applied
lateral to the rods. Routine
closure of the wound.
Smooth postoperative recovery with normalization
of the power of the right foot.
Comments
The patient is a difficult case to
estimate. Only with use of special software such as ORS
Visual explained the real wrong position of the screw.
Foraminotomy is a must in these cases to
eliminate all the compressive elements.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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
CT-scan reformatted using ORS Visual showing wrong direction of the
right upper screw.
The upper screw looking as be inside the canal, but this picture
after removing the fractured fragments and the root was inspected
visually and even the screw is thicker than the others, but it is
actually inside the pedicle and the 15 mA DNS stimulation of the
screw did not trigger any response.
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 .
