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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10-MARCH-2014 KHADRA SAEED MUHAMED 60 YEARS
SPONDYLOLISTHESIS L3-4 AND RETROLISTHESIS L4-5 WITH SEGMENTAL STENOSIS.
The patient came to the clinic 01-November-2011
complaining of LBP for 1 month with left
sciatica for 4 months. On examination at that
time she was not limping, with minimal scoliotic
stance. SLRS was 90 degrees both sides without
pain and there was weak dorsiflexion left foot
lumbar spine done 23-November-2011 showed mild
spondylolisthesis L3-4 with bulge L4-5 and L5-S1
with stenosis at L3-4. She was advised to keep
in conservative treatment. The patient then came
22-February-2014 complaining of LBP for 2 days
without sciatica. The patient is a known
hypertensive under treatment for 5 years.
On examination; the patient is in pain, limping, with exaggerated scoliotic
stance. SLRS was 80 degrees both sides with pain. There is weak dorsiflexion
right foot 4/5 and
left foot 3/5.
MRI of the lumbar spine done
22-February-2014 showing spondylolisthesis L3-4
and retrolisthesis L4-5 with severe segmental
Using C-arm, the L4-5 level identified.
Decompressive laminectomy L3, L4 and upper third
of L5. Foraminotomy left L4 and L5 roots.
Inspection of the disci. They were glistening
normal. The left isthmus of L3-4 was completely
destroyed with a lot of hypertrophic bone
fragments compressing the root and they were
flail. All these elements were removed.
Using Isobar TTL Module in system, 6 monoaxial
screws 6.2x45 were used to obtain transpedicular
fixation of L3,L4 and L5. The rods were bended
to adopt the natural curve of the area. Around
12 mm distraction was applied from the left side
to correct the scoliotic changes. Cross
connector was not applied, because the
supporting company did not provide this item.
The bone graft was added lateral to the rods and
routine closure of the wound. All stages of
surgery were performed with C-arm guide.
recovery. The power of the left foot became
The patient has a progressive course of
instability of different nature. All must be
We usually include connector to the construct,
but the providing company did not provide it.
This is not critical, but it was more preferable
to have it.
It was not necessary to violate the disc spaces,
since the annulus fibrosis of both disci were
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .