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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03-JUNE-2010 MUHAMED HMOUD ALI 30 YEARS CONDITION AFTER
DISCECTOMY C6-7 WITH MASSIVE DESTRUCTION OF C6 AND INSTABILITY OF THE C6-7
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6 hours after surgery with the patient ambulating with check X-ray AP and
to the clinic 01-June-2010 complaining of severe
neck pain and weak left upper limb after
performing discectomy in Egypt 2 months ago for
small disc of C6-7, followed by massive
infection in the anterior and posterior aspect
of the paravertebral spaces.
MRI of the cervical
spine performed 08-May-2010 after surgery
showing severe destruction of C6 with almost the
lower 2/3 of the body is removed with a cavity
full of puss and inflammatory process involving
the anterior and posterior aspect of the
there is severe weak left triceps muscle3/5 and
the grip and extension of the left hand was 4/5.
There is no myelopathic syndrome.
MRI of the cervical
spine performed 02-June-2010 showing
regression of the inflammatory process of the
posterior aspect of the paravertebral tissues
with huge empty space at the C6-7 level with
destruction of C6. Routine X-rays of the
cervical spine showed instability of the bony
structures. There still liquid inside the
Using part of the incision which was running
parallel to the SCMM, the bony defect of C6-7
was identified and the infected disc material of
C6-7 was removed. It became clear that the
surgeon attacked not the disc space, but instead
the lower 2/3 of C6 bony body. A 17 mm fibular
graft was harvested from the right leg and
reconfigured so as to accept the bony and disc
space level, Using Atlantis Medtronic 2 level
miniplate 35 mm length the fibular graft was
attached to the miniplate and fusion of
C5-6-7 was achieved. All the stages were
controlled under image-intensifier. Check for
stability of the construct was performed with
different stress manipulations.
Routine closure of the wound and smooth postoperative recovery with
full recovery of the power of the left upper
From the start, the patient
was not in need for any surgery. This can be
concluded from the MRI data performed
The incision was a strange
one, extending to the right sterno-clavicualr
junction, which means that the first surgeon is
not familiar with these kinds of surgeries.
Partial lower 2/3 coporectomy
of C6 was performed, not discectomy, which also
confirming that the surgeon is acting without
minimal knowledge to the anatomy.
Infection must be localized
to the area of surgery, but it was spreading far
reaching the inferior aspect of the occipital
bone. It is the first time in my life have the
opportunity to see such spread of infection.
Using cage in this case is
not the right option. The best option is to use
fibular graft, which can be freely drilled and
reconfigured to accept the space. It can resist
infection in the near future. The iliac bone
graft is not ideal, because it is fragile and
can be resorbed by possible inflammatory
This case is an example for
some surgeons, that they do surgery without
trying even to know the essential basics of
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 .