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Dr. Ali Al-Bayyati and Dr. Munir Elias

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.fr

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11-DECEMBER-2012  KHERIYE IBRAHEEM HAKOOZ  73 YEARS  SEVERE LUMBAR CANAL STENOSIS L2-3, L3-4  WITH SPONDYLOLISTHESIS L3-4.

 

Anamnesis

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The patient came to the clinic 06-December-2012 complaining of LBP for 10 years with bilateral sciatica for 3 months more the right. She cannot walk more than 300 meters with intermittent claudication. Her condition is deteriorating. The patient is a known hypertensive in medication for 2 years and underwent right CT release 30 years ago by me and right cataract removal 1 year ago. She has tinnitus left ear since childhood.

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MRI of the lumbar spine done 22-October-2012 showing severe lumbar canal stenosis L2-3, L3-4 with spondylolisthesis L3-4.

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On examination: the patient is limping, walking bended anterior with exaggerated scoliotic stance. SLRS was 85 degrees in the right with pain. There is weak dorsiflexion both feet -4/5. There is severe OA both knees.

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Skeletonization of L2,3,4 and L5. Decompressive laminectomy of L2,3 and upper half of L4. There was severe stenosis at L2-3 and L3-4 levels with kissing facets. There was overmobility of L2-3 and L3-4. Foraminotomy of the right L3 and L4 roots. Discectomy of L2-3 and L3-4 with insertion of TraXis 7x9x21 mm PEEK TLIF to both disci with harvested bone graft and NovaBone. 2 polyaxial Zimmer transpedicular screws inserted to the L3 body. 2 fixed screws were inserted to L2 body and one polyaxial to the left side of L4 and monoaxial screw to the right side of L4. All screws were 6.5x40 mm length. The fusion was achieved with slight compression with 2 rods 5 mm diameter and 65 mm length. Cross connector 72 mm length was inserted to obtain more stability to the spine. The NovaBone and harvested bone was inserted lateral to the rods.

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Routine closure of the wounds. Smooth postoperative recovery. The power of both feet became normal.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient has stenosis with extruded disc at L2-3 and spondylolisthesis of L3-4. Decompression and fusion of all segments is the best option in this case.

Postoperative check X-ray showing the position of the screws and the cages.

 

 

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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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