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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14-MAY-2012 KHETAM ABDALLA ABU-JEISH 62 YEARS
SPONDYLOLISTHESIS L4-5 WITH OLD EXTRUSION L5-S1 RIGHT SIDES.
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.
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.
examination, the patient is limping with
stance. SLRS was 70 degrees right side with same
neurological deficit as before with the addition
of weak dorsiflexion left foot 4/5.
spine with LSS-X-ray dynamic study repeated the
same previous results.
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.
closure of the wound. Smooth postoperative
recovery and the power of the feet became
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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.
The right S1 root was swollen, which means long
standing right sciatica after surgery.
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 .