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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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04. 04-NOVEMBER-2007
SUAD ABDEL-NABI KHALEEL 45 YEARS LCS L3-4,
L4-5 AND OLD PLD L5-S1 RIGHT SIDE WITH I-DEGREE
SPONDYLOLISTHESIS L4-5
Anamnesis
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The patient came to the
clinic 20-October-2007 complaining of LBP with
left sciatica for 2 years after falling down.
Right sciatica took place the last 3 weeks after
the mother death. |
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MRI lumbar spine done
04-July-2007 showing LCS L3-4, L4-5 and L5-S1
with spondylolisthesis of L4-5 and extrusion of
L5-S1 right side. |
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On examination: the patient
has scoliotic stance with weak dorsi and
planterflexion both feet. SLRS was 90 degrees
both sides. |
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The patient was sent for
another MRI with MRMyelography of the lumbar
spine with dynamic X-ray studies. The same
findings were observed and about the
overmobility of the L4-5 was not conclusive. |
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It was explained to the
patient and relatives, that the patient needs
decompression of the stenosed segments and
exploration of the overmobility will be studied
during surgery. |
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Skeletonization of L3 down to
the sacrum was performed after putting the
patient in ISIS Inomed IOM using pedicle screw
scenario. |
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Check for instability of L4-5
was not convincing. Decompressive laminectomy of
L4, L5 and partial of L3 and upper rim of the
sacrum was performed. The dura was very thin due
to severe compression all over the field.
Foraminotomy of right S1 root was done and there
was a small tear below the axilla due to severe
compression, which was stitched using nylon 6
zero. Check for segmental instability was
performed several times and inspection of the
L4-5 isthmi and the facet joints applying
considerable amount of force denied the presence
of instability. |
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During the foraminotomies,
using MEP protocol, the stimulation threshold of
the running roots were ranging from 3-4 mA. |
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Inspection of the L5-S1
extrusion showed that it is very hard and not
movable, for what it was decided not to remove
the extrusion, nor to use the transpedicular
screws for fixation. |
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Smooth postoperative recovery
with normalization of the power of the right
foot. |
Comments:
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The presence of I-degree of
spondylolisthesis is not sufficient to go for
transpedicular fixation. Staged check for
instability, must be performed in all steps of
surgery. If there is suspicion about instability
take place, then transpedicular screw fixation
is mandatory. Otherwise it is better not to fuse
the stable structure. |
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The presence of ossified
extrusion at L5-S1 made it reasonable not to
touch the extrusion, since foraminotomy of the
right S1 root was sufficient to resolve the
problem and in case of disc removal another
possibility for recurrence will emerge later. |
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