Munir Elias 20-12-2013

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.fr

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
cns-online.com
cns.surgery
cns.today
e-neurosurgery.com
neurosurgery.ag
neurosurgery.bz
neurosurgery.co
neurosurgery.cz
neurosurgery.fr
neurosurgery.gallery
neurosurgeryvideo.gallery
neurosurgicalvideo.gallery
neurosurgery.guru
neurosurgery.me
neurosurgery.mx
neurosurgery.photos
neurosurgery.tips
neurosurgery.tv
neurosurgery.tw
neurosurgeryspine.org

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.com
neurosurgicalencyclopedia.net
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
craniopharyngiomas.net
ependymomas.com
ependymomas.net
glioma.co
gliomas.info
glioma.ws
meningiomas.info
meningiomas.org
neurooncology.me
neurooncology.tv
neurooncology.ws
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com
pituitaryadenoma.net
schwannomas.com
theneuro-oncology.com

Neuroanatomical Sites
diencephalon.info
diencephalon.org
humanneuroanatomy.com
medullaoblongata.info
mesencephalon.org
microneuroanatomy.com

Neuroanesthesia Sites
neuroanesthesia.info

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com
neurophysiology.ws

Neuroradiological Sites
neuroradiology.ws

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com
vascularneurosurgery.net

Personal Sites
cns.clinic
cns-clinic.net
cnsclinic.org
munirelias.com

Spine Surgery Sites
spine.surgery
spinesurgeries.org
spinesurgery.ws
spondylolisthesis.info
paraplegia.ws

Stem Cell Therapy Site
neurostemcell.com


Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

02-JULY-2014  WAFA IZZIDEEN MUHAMED AL-ALI  57 YEARS  GANGLION? OF THE RIGHT L4-5 FACET COMPRESSING THE RIGHT L5 ROOT AFTER SURGERY FOR RIGHT L4-5 EXTRAFORAMINAL  EXTRUSION.

 

Anamnesis

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The patient was operated by me 20-May-2014 for right far-lateral disc L4-5 with stenosis. The patient came 05-June-2014 with slight improvement with SLRS 10 degrees in the right with normalization of the power of the right foot. She still complaining of right sciatica with hypalgesia right L5 and S1 roots. MRI lumbar spine done 07-June-2014 showing no recurrence of L4-5 with swollen right L5 root. The patient then was admitted to Shmaisani hospital 15-June-2014 for fainting attack and MRI of the brain showed mastoiditis right side. Cardio consultation revealed regurgitation of the aortic valve. The patient then came 28-June-2014 telling that the LBP with bilateral sciatica more the right increased the last week.

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On examination; the patient is not limping. SLRS was 85 degrees without pain in the right. Hypalgesia right L5 and S1 roots territories.

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The patient was sent for new investigations: MRI lumbar spine with contrast done 28-June-2014 showing severe stenosis at L4-5 with ganglion? arising from the right L4-5 facet, or huge recurrence causing severe foraminal compression.

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The old wound refreshed. During superficial dissection, clusters of the inserted at first surgery was seen with reactionary changes around it in the subfascial layers. These reactions were seen at all sites of dissection, denoting that the bone graft never became solid and it gradually completely escaped from the disc space to the surrounding tissues. Refreshment of the right upper corner of L5 lamina to follow the dura up. A huge material of bone graft was seen intermingled with the ligamentum flavum. The right L4-5 facet was exposed and all the reactionary masses were removed. There is no proper ganglion in the area. Instead there is the bone graft and a huge recurrence of the disc material with up and downward migration. The huge recurrence was removed in several pieces. The disc space was empty and further cleaning of disc space was performed to see if any bone graft was left there. There is no remnants of bone graft in the disc space. Wide foraminotomy of the right L5 root was achieved. Routine closure of the wound.

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Smooth postoperative recovery.

 

 

Comments  

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The estimated postoperative recurrence is still was around 7%, but here 2 ml of bone graft was inserted to the disc space to prevent future collapse of the area and promote fusion of L4 and L5. That was what supposed to be in the first surgery.

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During this revision, the bone graft will not ossify within 30-40 min as it was told to us. It   gradually and completely escaped the intradiscal space , causing during that reactionary changes around the root, which was swollen at certain stage, and reactionary changes around the facet mimicking ganglion and intradiscally triggering the recurrence.

Lessons  

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Do not ever put Hydr'Os inside the disc space. It will never ossify, instead it will slip out causing several reactionary changes with trigger to high recurrence rate.

 

Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.

Leica HM500

Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014


Back Up!

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

WELCOME TO AL-SHMAISANI HOSPITAL

 

 

 

[2014] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved