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.

3. 11-MARCH-2007 FATIMA SAEED SANDOQAH 45 YEARS III DEGREE SPONDYLOLISTHESIS L4-5 WITH BILATERAL ISTHMOLYSIS.

Anamnesis

	The patient came to the clinic 07-January-2007 complaining of LBP for 15 years with left sciatica. LSS-X-ray done 10-October-2006 showed II-III degree of L4-5 spondylolisthesis.
	The patient was limping with agonizing pain with exaggerated scoliotic stance.
	On examination: the patient had weak dorsi and planterflexion both feet
	MRI of the lumbar spine performed showing spondylolisthesis L4-5 with isthmolysis both sides.
	Decompressive laminectomy L4 and 5 with foraminotomy for L4 and L5 roots both sides was achieved and all the compressive elements were eliminated.
	Using the USS II pedicular screw system with upper screws length 40 mm and diameter 6.2 mm and the lower screws with length 35 mm and diameter 6.2 mm, transpedicular screw fixation was achieved aided with crossing bridge.
	The dura was very thin at the lower level, that a microscopic point caused CSF leak, which was stitched using 6 zero nylon.
	Lateral to the rods , chips of harvested bone was inserted to achieve later bony fusion.
	Routine closure of the wound and smooth postoperative recovery with improvement of the motor power both feet.

Comments:

	Spondylolisthesis I-III degree with clinical manifestations and progressive clinical course, make it mandatory to perform transpedicular screw fixation.
	The goal of such surgery is to eliminate the overmovement and remove the hypertrophied elements due to pseudojoints at the isthmolysis sites and decompress all the neural structures. Otherwise, the surgeon could unintentionally harm them, which is not the case, when he bring them under direct vision.