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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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7. 10-APRIL-2007
HUSNIYEH NAJAH SUBHY 40 YEARS HUGE EXTRUDED
DISC L4-5 WITH RIGHT DOWNWARD MIGRATION AND RECENT
FRACTURE BOTH ISTHMI OF L4-5 AFTER TRADITIONAL
TREATMENT.
Anamnesis
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The patient came to the
clinic 08-April-2007 complaining of severe LBP
with agonizing right sciatica for one month. |
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MRI lumbar spine done
05-April-2007 showing huge extruded disc L4-5
with right downward migration. |
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On examination: The patient
could not stand for scoliotic assessment and
Romberg test. She had SLRS right 40 degrees and
5 degrees in the left. She had drop left foot
with weak planterflexion of the same foot with
hypalgesia left L5 and S1 root territories. |
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During skeletonization, the
L5 lamina is flail. Inspection of the isthmi
both sides revealed recent transverse fracture
both of them. Revision of the MRI preformed 5
days ago did not show the presence of such
fracture. |
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Foraminotomy of right L5 root
and the huge extruded disc was removed in
several pieces lateral to the axilla. |
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Meticulous cleaning of the
disc space was performed from the right side and
drilling of the disc space to achieve a 4 mm
diameter window to the disc space. A big piece
of bone harvested from the L4 spinous process
was harvested and remolded to adapt it from
intradiscal graft. |
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Using the spreader the bone
was pushed with impacter to the cavity to have
later fusion of the area. After insertion of the
graft the spreader released and check for
stability of the graft, showed that back
slippage is impossible. |
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The epidural fat which was
shifted upward due to severe compression, was
transferred down to the level of relaxed roots. |
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Smooth postoperative recovery
and normalization of the power of both feet. |
Comments:
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The patient is denying recent
trauma to the spine but, she admitted that she
went for traditional local treatment modalities,
such are doing burn in certain points. But
the brother admitted that she felt down from 4
meters 1 month ago. |
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This case is not unusual,
since the local population believe in certain
traditional therapies, such as burning and using
woody instruments, which could cause such
fracture. These low intelligent people usually
try to hide this information and such findings
are usually discovered during surgery. |
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Due to poverty, the surgeon
must act to resolve the fracture problem with
minimal cost. The bone was harvested from the
spinous process and impacted to the disc space
with tension to aid future fusion. |
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Preservation of the epidural
fat and using it to cover the most mobile neural
parts is the best solution to prevent scar
formation and ease his pain in the long run. |
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