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.

5. 11-JUNE-2007 DR. UMAR ISSA ABABNEH 55 YEARS HUGE EXTRUDED DISC L4-5 WITH FAR UPWARD MIGRATION.

Anamnesis

	The patient is a pediatrician came to the clinic 05-June-2007 complaining of LBP for 5 years. He had similar episode 10 moths ago. Exacerbation the last month with bilateral sciatica more the left.
	On examination: he was limping with scoliotic stance. SLRS was 70 degrees in the right with pain and 75 degrees in the left. He had weak dorsiflexion both feet.
	MRI lumbar spine performed 30-May-2007 showed huge extrusion of the L4-5 disc with upward migration reaching the above disc level.
	Bilateral flavotomy without using image-intensifier was performed to which to be the L4-5 disc space with bilateral cleaning of the disc space of which to be supposed the L4-5 disc space. The disc material was friable, but the huge extrusion was absent.
	Suspicion about the level came in mind and check level by image-intensifier showed that the level was L3-4.
	Laminectomy of L4 was done and the L4-5 disc was cleaned from both sides. The huge extrusion was adherent to the dura and it was possible to remove it by piece-meal fashion from both sides. After that the roots became relax and check of the foramina were negative for compression.
	Routine closure of the wound with smooth postoperative recovery and normalization of the power of both feet.

Comments:

The patient's anatomical landmarks were misleading, that the level was wrong. It is mandatory to perform image-intensifier check, even when the disc is at L4-5 or L5-S1 level to avoid such a mistake. Over than 3000 operations at these level were performed by me, without using the image-intensifier, but the patient was doctor and the recomenditis, took place with this fashion - wrong level. For that reason, it is better to use image-intensifier to avoid such mistake, without considering the amount of your personal experience.