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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17-DECEMBER-2011 NURY ASHOUR AL-TREKY 57 YEARS
RESIDUAL AFTER POSTERIOR DECOMPRESSION FOR CERVICAL CANAL STENOSIS WITH PCD
C5-6, C6-7.
Anamnesis
The
patient came to the clinic 21-November-2011
complaining of difficult walking with neck pain.
The patient was operated 2 years ago for
cervical canal stenosis by posterior
decompression. The patient did not noticed any
improvement after surgery. The patient condition
continued to deteriorate and he is walking with
spastic pattern. The patient has arterial
hypertension for three years and he is
complaining of headache since that time.
On
examination, the patient has shuffling gait
and limping having weak grip left hand 4/5 ,
extension 3/5 biceps brachii right 4/5 and
triceps 3/5. There is weak dorsiflexion right
foot -4/5, left foot -4/5 and planterflexion
left foot 4/5 with left sided sciatica. Hoffmann
was positive in the right and Babinski both
sides.
The
patient was sent for investigations, which
revealed pontine old infarction and posterior
decompression C4-5-6 with mild stenosis C6-7 and
PCD C5-6, 6-7 left side with malacia of the
spinal cord at these levels.
It was
explained to the patient that he has multiple
problems, that anterior decompression with
fusion could help him, only if the
anterior spinal artery irritation playing a
role in his condition and his deterioration. The
patient insisted for surgery.
Discectomy of C5-6, C6-7 with
osteophytectomy was done. Fidji PEEK with
NovaBone 12x15x6.1 mm was inserted to C5-6, and
12x15x6.9 mm to C6-7 level. Zimmer cervical
plate 2 level 40 mm length with 2 fixed 16 mm
screws to C6 and 4 variable 16 mm screws to C5
and C7 were used to fuse C5-6 and C7.
Routine
closure of the wound. Smooth postoperative
recovery with improvement of the power of four
limbs.
Reformatted postoperative CT-scan showing the construct.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
connection.
Comments
The patient had posterior decompression of the
cervical stenosis. The presence of pontine old
infarction and malacia of the spinal cord, make
it difficult to estimate the deleterious effect
of the disc extrusions and the role of the
anterior spinal artery syndrome in this case.
The patient was urging for surgery, and it
was explained to him that the expected recovery
is doubtful, but he insisted.
The patient showed dramatic improvement after
surgery, that he could predict the improvement,
for what, he insisted for 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 .
