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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23-AUGUST-2013 MUNTHER MUHAMED FAYEQ 40 YEARS I
DEGREE SPONDYLOLISTHESIS L5-S1 AND BULGE L4-5.
The patient came 22-August-2013 complaining of
right sciatica for 4 years and LBP for 2 years
with exacerbation of LBP the last year and right
sciatica the last 2 months.
MRI lumbar spine performed 26-June-2013 showed
bulge L4-5 and L5-S1 with I degree
spondylolisthesis L5-S1. Dynamic studies
confirmed the last data.
On examination the patient cannot walk more than
400 meters with occasional episodes of agonizing
LBP and conservative treatment fail to relief
the pain. SLRS was 80 degrees with pain in the
right. Despite the reluctant attitude of the
surgeon, i.e., me, the patient is urging for
Exposure of L4,5 and upper
sacrum and lower half of L3 laminae. The lamina
of L5 is fail, floating to all directions. The
flail lamina removes and foraminotomy both S1
roots achieved. Discectomy L5-S1 was performed
from the right side and Novel TL TLIF cage
10x15x50 mm inserted from the right side with
Stryker BoneSave. Using Isobar TTL module In,
transpedicular screws 6.2x45 monoaxial was
inserted to L4 and L5 both sides. 2 polyaxial
6.2x50 mm screws were inserted to the upper
sacrum. Using 2 rods bended 5.5 x 50 mm length
and cross connector were used to fix L4,L5 and
S1 with slight compression at L4-5 and L5-S1
levels. His own harvested bone and BoneSave were
used lateral to the rods.
recovery. The power of both feet became normal.
The patient is urging for surgery, despite the
scant radio-neurologic data. It could be that
some dynamic trigger pain factors are playing a
role and they are not will seen in the
radio-neurologic setup of the patient.
The flail lamina of L5 was the source of pain.
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