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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Multigen RF lesion generator .
20-JULY-2014 JAMIL AHMAD JAWASH 59 YEARS
LUMBAR CANAL STENOSIS L2-3.
The patient was operated by me twice for
cervical canal stenosis the second operation was
23-February-2013 by posterior decompression.
The patient showed considerable improvement over
the months, then came 18-June-2014 complaining
of LBP for 2 months without sciatica with cramps
both lower limbs. He cannot walk more than 30
meters due to intermittent claudication.
On examination; the patient walking bended. SLRS was
80 degrees both sides. Weak
dorsi and planterflexion both feet -4/5. There
is hypalgesia both L5,S1 territories. The left
hand extension and the left triceps were -4/5,
which was the same as the last visit in
The patient was sent for investigations and the
MRI lumbar spine performed 01-July-2014 showing
severe lumbar canal stenosis L2-3 with mild
stenosis at L1-2.
Using C-arm, the L2-3 level was identified.
During skeletonization, it was evident that the
upper half of the L4 spinous process suffered
fracture, but the whole area is stable.
Decompressive partial laminectomy of the lower
2/3 of L3 and upper 2/3 of L4 until the epidural
fat was seen in both levels. Foraminotomy of
both L4 roots. During inspection of the disc of
L3-4, which was hard and smooth, massive
bleeding from the epidural veins took place,
because the patient was obese. It was stopped by
muscles applied to the left upper corner.
Hemostasis. Routine closure of the wound.
Smooth postoperative recovery. The power of both
feet became better.
The LCS is a progressive disease and the
sooner the surgical decompression the best the postoperative
The patient is a complicated case and he
underwent 2 surgeries for cervical stenosis and has malacia
of the spinal cord. It is hard to predict the level of the
postoperative recovery after this last surgery. Time will
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
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 .