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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22-FEBRUARY-2014 MBARAK SALEH HILWAN 81 YEARS
RESIDUAL AFTER 2 SURGERIES WITH SPONDYLOLISTHESIS L4-5.
The patient came to the clinic 16-February-2014
from YAR complaining of LBP and right sciatica
for 10 years with deterioration the last 2
years. Using crutches the last 2 months with
inability to walk more than 200 meters with
intermittent claudication. He was operated 1997
in Egypt 1997 for PLD L4-5 and then in Yemen
2004 for recurrence. He is a known diabetic for
10 years in treatment. LSS X-ray done
12-February-2014 showing II degree
spondylolisthesis L4-5. MRI lumbar spine done
18-March-2012 and repeated 11-February-2014
showing spondylolisthesis L4-5 with severe
On examination; the patient is limping with
exaggerated scoliotic stance. He has bilateral
sciatica more the right with SLRS 70 degrees in
the right and 80 degrees in the left with pain.
The right AJ is absent. Complete drop right foot
with weak planterflexion -4/5. Dorsiflexion left
foot -3/5 and planterflexion 5/5. There is
hypalgesia right L5, S1 roots territories.
Skeletonization of L3 lamina, upper sacrum,
lateral masses of L4-5, L5-S1. Foraminotomy
right L5 root. Discectomy L4-5 with insertion of
TLIF cage Novel TL 6x23x5 mm wit bone graft from
the right side. Using Isobar TTL Module in 2
monoaxial screws 6.2x45 mm inserted to L4 and 2
polyaxial screws 6.2x45 mm to L5 body. Rods
5.5x50 mm bended to accept the natural curve of
the area with cross connector were used to
achieve fusion of L4-5 with slight compression.
The bone graft was added lateral to the rods.
Routine closure of the wound.
recovery. The power of the left leg became
normal and slight improvement of the drop right
The patient mostly having iatrogenic
spondylolisthesis after the 2 performed
The lowest vertical TLIF cage was used to avoid
overstretching the running nerves, since the
disc space of L4-5 was very narrow.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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