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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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03.
06-AUGUST-2007 WALEED AWWAD SALEM 22 YEARS
RTA 2 WEEKS AGO WITH CONTUSION OF THE LEFT INTERNAL
CAPSULE AND MULTIORGAN INJURIES AND FRACTURE-DISLOCATION
C7-D1 WITH PARAPLEGIA BELOW TH-5.
Anamnesis
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The patient was admitted 10
days ago for multiorgan injuries after RTA and
was operated for internal bleeding and put in
ventilator. Upon recovery from ventilation, it
was noticed that he had right lower limb plegia
and CT-scan performed showed brain edema and
suggestion for axonal injury of the left
internal capsule was put clinically. He had also
weak right upper limb more the proximal muscles.
Fracture of the D5 was suspected and confirmed
by CT-scan, but there was no gross displacement. |
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Upon activation of the
patient 2 days ago, the patient progressed dense
paraplegia below Th 5. |
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MRI of the brain and the
whole spine was performed and confirmed the
presence of damage to the left internal capsule
and presence of severe fracture-dislocation of
C7-D1. |
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The patient was operated the
next day and after reduction of C7 upon D1,
discectomy of C7-D1 was performed. The upper
anterior part of the D1 body was badly
destroyed. |
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Using cervical miniplate,
fusion of C7-D2 was performed and the chips of
the fractured bone put back to place. Another
screw was used to fix the left part of the more
or less acceptable part of D1 body. |
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Smooth postoperative
recovery. Neurologically the same. |
Comments:
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The patient has 2 causes of
his neurologic problem, the internal capsule and
the hidden fracture dislocation of C7-D1.
Presence of minor fracture of D5 misled and
hided the presence of the major
fracture-dislocation at C7-D1 which is difficult
to note in the usual X-rays. This later caused
the further neurologic deterioration upon his
activation. |
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This case support the need
for whole body MRI of the patient in the early
stage of the multiorgan trauma to avoid such
mistakes. |
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