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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27-JULY-2013 MURAD MUHAMED ALIYAN 42 YEARS EXTRUDED DISC C6-7
WITH SEVERE SEGMENTAL STENOSIS. RESIDUAL AFTER OLD FRACTURE C5 AND DISCECTOMY
The patient came to the clinic 16-Ocotber-2001
complaining of progressing weakness of four
limbs, numbness both hands, more the right
with dyspnea the last 2 months. The patient due
to falling down 31-July-1990 got fracture C5
with complete paraplegia, for what surgical
correction and stabilization done at KHMC
immediately after insult, with partial recovery
over several months. Conservative treatment was
recommended. The patient then came
25-January-2010 complaining of deterioration of
his walk. The hypalgesia below C4 disappeared,
but there is weak grip and extension right hand
2/5, triceps right arm 3/5 with weak quadriceps
right leg 3/5, abduction and adduction of the
right knee 4/5, planterflexion and dorsiflexion
right foot 3/5. MRI cervical spine performed
17-January-2010 showed huge extruded disc C3-4
with spinal cord compression. Discectomy with
fusion was advised and he underwent surgery in
The patient then came 25-July-2013 complaining
of weak four limbs with general weakness and
difficult walk the last 3 months with dyspnea
and intrascapular pain with left sciatica.
On examination: the patient is limping with
exaggerated scoliotic stance. There is pain when
turning the head to the right down and up and
bending the head to both shoulders. The power of
the right upper limb the same as before and
there is weak grip and extension of the left
hand. The weakness of the right lower limb more
pronounced than before, and there is weak dorsi
and planterflexion left foot 4/5. The right
lower limb is spastic and Babinski and Hoffmann
signs were positive and brisk both sides. Clonus
both feet, more pronounced in the right side.
MRI cervical spine performed 15-June-2013
showing huge PCD C6-7 with severe compression of
the spinal cord at this level. The spinal cord
has gross malacia all over the cervical spinal
canal. MRI lumbar and dorsal spine done also
showing bulge D6-7, D10-11, L4-5 and L5-S1.
Cervical X-ray done 25-July-2013 showing a
cervical disc system inserted to C3-4 with
calcification around it. Fusion of C4-5-6 in one
Discectomy C6-7 with removal
of the bone elements compressing the spinal
cord. The dura was seen all over the removed
disc posterior borders. Insertion of Fidji
cervical cage 12x15x6.9 mm with NovaBone. Using
Trinica cervical plate 24 mm length, fusion of
C6-7 done with three fixed screws 16x4.2 mm and
one 14x4.2 mm to the left side of C6 body. C-arm
was used at all stages of surgery.
Routine closure of the wound.
Smooth postoperative recovery.
The patient after fusion of C4-5-6 progressed
over time extruded disci at near by segments.
C3-4 was treated 2 years ago and now C6-7
required surgical correction.
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