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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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6.
12-JUNE-2007 HALIMEH AHMAD UMAR 60 YEARS OLD
PATHOLOGIC FRACTURE L1 WITH COMPRESSION AT THE SAME
LEVEL.
Anamnesis
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The patient came to the
clinic 29-January-2007 after falling down 90
days ago from 150 cm height with resulting
fracture L1 with compression of the spinal cord. |
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MRI performed 23-Jaunary-2007
showed resorption of L1 and fragments
compressing the spinal cord with malacia of the
spinal cord at that level. |
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On examination: the patient
cannot walk in wheelchair with pressure sores in
the heel of the right foot. The left foot is
amputated at the 5 cm above the level of the
toes 20 years ago. |
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The patient is incontinent
with cauda equina syndrome with anaesthesia
below both knees with weak both quadriceps 4/5
and adductors 4/5 and feet dorsi and
planterflexion and abduction of the knees
0/5. She had agonizing pain when setting.
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The patient was sent for bone
density study, which confirmed the presence of
severe osteoporosis. |
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Conservative treatment
started with Somazina, Nucleo-CMP, Nootropil,
miaclacic nasal spray, Oscal-D and
dorsolumbar support. |
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The patient came
05-March-2007 with new MRI showing the
same picture, but the bone density study
confirming slight improvement.
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The patient came another time
06-June-2007 with new MRI performed
04-June-2007 showing the compression with
malacia of the spinal cord. |
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On examination: slight
improvement of the power of the left lower limb:
the left quadriceps 5/5 and adductors 5/5
but the abductors 2/5 and 0/5 of feet dorsi and
planterflexion. There was still anaesthesia of
the left lower limb 15 cm below the level of the
knee. Bone density studies confirmed improvement
of the bony structures strength. |
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It was explained to the
relatives, that decompression is needed and the
expected results are related to the degree of
the spinal cord recovery. Stabilization of the
area could arise during surgery. |
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Skeletonization of D12, L1
and 2 was performed. Check for stability, showed
acceptable stable bony alignments. Laminectomy
of L1 and partial of D12 and L2 was performed,
trying during that to preserve the essential
components providing the stability. Check for
stability after decompression showed that the
bony alignments having the same stability as
before laminectomy. Plan for fixation was
abandoned. |
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Smooth postoperative course,
and the patient could move the feet dorsi and
planterflexion. |
Comments:
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The patient was not operated
from the first visit, because she had severe
osteoporosis and other medical problems. She
came 90 days after the essential insult. |
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Surgery was not performed,
only after long discussion with the relatives,
that decompression could help in the process of
improvement without any guarantee.
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The necessity for fixation of
the spine could be resolved only during surgery,
which proved in this case unnecessary. |
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