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 NEWS
January/06/2007
Surgical treatment in
paraplegia survey:
Cross-anastamosis in paraplegia below D9 started to give
results. The last documented case operated 1 year ago in a patient from Israel came
to the clinic 3 weeks ago. ECS and EMG performed showed that there is
starting innervation of Th 11 and 12. The patient's lower limbs muscles
became bulky and he could contract the lower abdominal muscles and some
movements in the pelvic girdle. Crude sensation descended down to the
inguinal level both sides. If you are more interested in this topic,
click here!
March/08/2007
Tuberculosis of the
spine
In the last 2 years the incidence of
tuberculosis of the spinal column is becoming more frequent and having
different clinico-morphologic picture. This phenomenon is alarming sign
as the residual of the use of dirty bombs and several radioactive
materials in the surrounding dirty wars in the region. For demonstration
click here! and
here!
20-AUGUST-2007
SIEMENS Digital C-arm is implemented and
functioning in the Shmaisani hospital.
30-AUGUST-2007
The Inomed ISIS Highline neurophysiologic
navigation system start to work at the operating room.
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3. 01-APRIL-2007
UTHMAN TAHER AL-WAZEER 35 YEARS EXTRUDED
DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
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The patient came from YAR to the
clinic 31-March-2007 complaining of agonizing
left sciatica for 2 months with escalation the
last week and numbness of the left L5 and S1
roots territory. |
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The patient was operated 25
years ago for PLD L4-5 in UK. |
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MRI of the lumbar spine
performed 24-March-2007 showing extruded disc
L5-S1 with no recurrence at L4-5 level. The MRI
was of bad quality. |
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On examination: the patient
walking with aid and crutches. The patient is
limping and has scoliotic stance. SLRS was 35
degrees in the right and 5 degrees in the left.
The left AJ is absent in the left with analgesia
for pin-brick at the left S1 root territory and
hypalgesia of the L5 territory. There is weak
dorsiflexion left foot 4/5. |
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The patient was sent for new
MRI of the lumbar spine, which was performed and
more clearly demonstrated the extrusion and the
left side downward migration of the piece. |
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Left L5-S1 hemiflavotomy with
left S1 foraminotomy was performed. The root was
severely compressed from anterior and it was
necessary to perform discectomy of L5-S1
to regain some ample and to withdraw the
extrusion back to the disc space cavity, after
what it was possible to remove the extrusion in
one piece lateral to the axilla. |
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Further cleaning of the disc
space was performed from the left side. The root
regained relaxed position. Routine closure. |
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Smooth postoperative recovery
and normalization of the power of the left foot. |
Comments:
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The extruded disc was not
large enough, but the root was severely
compressed by the extruded and downward
migrating piece, causing complete loss of the
function of the left S1 root. |
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So as to avoid surgical
trauma to the already traumatized root, it was
necessary to decompress the disc material, then
the extrusion was removed, after pushing it
inside the disc space. Avoidance of surgical
trauma to the neural structures, make
postoperative deterioration of them a rarity.
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