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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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4. 02-APRIL-2007 BASSAM
FAYEZ AL-AUDAT 37 YEARS HUGE EXTRUDED DISC
L5-S1 LEFT SIDE.
Anamnesis
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The patient came to the
clinic 08-March-2007 complaining of LBP for 5
years with left sciatica. Exacerbation of
the LBP with left sciatica the last 10 days with
numbness of the left L5 and S1 roots. |
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On examination: The patient is
limping and has scoliotic stance. SLRS was 80
degrees in the right and 50 degrees in the left.
The left AJ is absent in the left with analgesia
for pin-brick at the left S1 root territory. There is weak
planter and dorsiflexion left foot 4/5. |
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MRI of the lumbar spine
performed 05-March-2007 , showing huge extrusion
L5-S1 with severe compression of the left
S1 root. |
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Left L5-S1 hemiflavotomy with
left S1 foraminotomy was performed. The root was
severely compressed from anterior and it was
impossible to reach the extrusion from under the
axilla. The upper most parts of the extrusion
was fragmented and removed from lateral the
axilla, after what the major portion came out. |
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Inspection of the annulus
fibrosis, showed a small defect and the
intradiscal material was strong by inspecting it
using a very tiny Swedish. It was decided not to
violate the disc space, since the space is
narrow. 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
large enough, and 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 fragment the upper most of the
extrusion to regain ample to shift the nerve to
remove the big extrusion. Avoidance of surgical
trauma to the neural structures, make
postoperative deterioration of them a rarity. |
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Considering that the disc
space is narrow and the defect in the annulus
fibrosis is small and the disc material is hard,
it was decided to leave the disc space
untouched. |
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