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.tv
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21-NOVEMBER-2011 NABEEL ABDEL-MUGHNY AL-ZGHAYER 53
YEARS SPONDYLOLISTHESIS L5-S1 WITH BILATERAL ISTHMOLYSIS.
Anamnesis
The
patient came to the clinic 07-December-2010
complaining of LBP and left sciatica for 1 year.
Exacerbation of left sciatica the last 3 months
and walking with difficulty. The patient is a
known diabetic and hypertensive for 4 years.
On
examination: SLRS was 80 degrees with pain in
the right and 20 degrees with more pain in the
left. There is weak
dorsi and planterflexion left foot 4/5.
The
patient was sent for MRI of the lumbar
spine, which was done 30-December-2010 showing
spondylolisthesis L5-S1 II degree with bilateral
isthmolysis, which were confirmed in the dynamic
studies. The patient was advised to undergo
surgery and he escaped for financial reasons for
a year, then he came 18-November-2011 urging for
surgery.
Laminectomy of the flail L5 was done.
Foraminotomy both S1 roots and left L5 root
achieved. The left L5-S1 lateral mass was
drilled out, so that the L5 root was seen
running at the most left side of the field.
Discectomy L5-S1 was performed from the left
side and Zimmer TraXis PEEK OPTIMA 11x11x21 mm
was inserted to the disc space with NovaBone
putty, aided with bone harvested from the
removed lamina. 2 monoaxial 6.5x45 mm screws
were inserted to the L5 pedicle. 2 polyaxial
6.5x45 mm screws were inserted to the upper
sacrum. The left screw was inserted and it was
penetrating the contralateral cortex around 3-4
mm, which was accepted. 50 mm length bended rods
were used and slight compression was applied at
the left side. There was no space to put
connector between the rods. The construct was
aided with melted bone harvested from the lamina
and lateral masses .
Routine
closure of the wound. Smooth postoperative
recovery with improvement of the power of
the left foot.
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Comments
The patient has unstable spondylolisthesis,
which needs correction, decompression and
fixation.
It is worthy to put connector between the 2
rods, but there was no place to put it.
Considering that the bone was marble-like solid
and the screws were inserted bicortical with
mild compression, it was seen that the connector
is not important in this particular case.
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 .
