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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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14-MAY-2012  KHETAM ABDALLA ABU-JEISH  62 YEARS  SPONDYLOLISTHESIS L4-5 WITH OLD EXTRUSION L5-S1 RIGHT SIDES.

 

Anamnesis

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The patient  came to the clinic 03-February-2002 complaining of LBP and right sciatica for 2 years. On examination at that time, the patient had scoliotic stance with SLRS 75 degrees with pain in the right and hypalgesia right L5 and S1 roots. The left knee jerk and both AJs are absent. There was weak dorsi and planterflexion right foot -4/5. MRI of the lumbar spine performed 05-February-2002 showing spondylolisthesis L4-5 with severe lumbar canal stenosis at this level with PLD L5-S1 right side. The patient was advised to undergo surgery, but she escaped.

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The patient then came 11-April-2012 complaining of exacerbation of LBP with more exaggerated scoliotic stance and and inability to walk more than 100 meters with intermittent claudication and right sciatica and numbness both feet.

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On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 70 degrees right side with same neurological deficit as before with the addition of weak dorsiflexion left foot 4/5.

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MRI lumbar spine with LSS-X-ray dynamic study repeated the same previous results.

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Skeletonization of L3-4-5 and upper sacrum down to the transverse processii. Laminectomy of L4 and L5  with foraminotomy of right S1 root. The root is swollen. The extrusion is bony hard not mobile, for what it was left in place. The mobile pseudoarthrotic L4-5 hypertrophied joints were removed. Most of its fragments were flail. Generous foraminotomy L5 roots both sides. Discectomy of L4-5 with insertion of TLIF 10x12x17 mm from the right side. with Ceraform bone graft granules 10 cc part to the left side of the disc cavity  and right side after insertion of the cage. Spineway polyaxial 6x45 mm screws inserted to L5 and monoaxial 6x45 mm to L4 bodies. Check image-intensifier performed at all stages of surgery. 55 mm bended rods were used with cross connector 55-70 mm  with sight compression to prevent slippage of the TLIF. Further bone grafts used parallel to the rods.

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Routine closure of the wound. Smooth postoperative recovery and the power of the feet became better.

 

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 escaped from surgery for 10 years. Surgical correction is the only solution. She could perform her surgery earlier, escaping the long years of suffering.

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The right S1 root was swollen, which means long standing right sciatica after surgery.

 


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