|
|
 |
|
|
 |
|
|
|
|
|
|
|
|
| |
 |
 |
|
 |
 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.
|
|
| |
 |
 |
|
|
|
|
|
 |
|
 |
4. 12-MARCH-2007
TAMAM MUHAMED BDIER 55 YEARS LCS L3-4 WITH
LEFT LATERAL SYNDROME WITH SLIPPED FRAGMENT FROM THE
LEFT L3-4 FACET JOINT.
Anamnesis
 |
The patient came to the
clinic 07-March-2007 complaining of LBP for 15
years without sciatica. The last 2 weeks
got exacerbation of LBP with left sciatica.
|
|
|
MRI lumbar spine performed
05-March-2007 showing huge extrusion of L3-4
with up and downward extension left side. |
|
|
On examination: the patient
is limping with scoliotic stance
with urgency and frequency of urination. SLRS
was 50 degrees in the right and 20 degrees
with shooting pain in the left. Complete drop
left foot with weak dorsiflexion right foot 4/5
and left foot 3/5. Sensory los of the midthird
and below the right forelimb and above knee of
the left lower limb. The patient is a known
diabetic for 5 years with hypertension
for 10 years. |
|
|
Partial decompressive laminectomy
of L3
and 4 with foraminotomy for L4 and L5 roots both
sides was achieved and all the compressive
elements were eliminated. |
|
|
The extruded fragment was
from the left facet joint and was severely
compressing the left L4 root at the root canal
level. |
|
|
Inspection of the L3-4 disc
space was negative for presence of any extrusion
from the disc, for what it was decided not to
violate it. |
|
|
Routine closure of the wound
and smooth postoperative recovery with
improvement of the motor power both feet. |
Comments:
|
|
It happens that, misreading
of the MRI can lead to disturbances in planning
of surgery. Surgery was needed in all
situations, but the surgeon must consider any
variations or possibilities and to be
open-minded for all possibilities.
|
|
|
The compressive elements
where coming from the left facet joint and the
presence of good epidural veins over the disc
space ruled out the disc as the origin of her
problem. LCS played a major role in escalation
of her deterioration, that such prolapsed facet
joint mimic the clinical picture of extruded
disc. |
|
|
The patient showed dramatic
improvement of her weakness, but the drop foot
regained some improvemt. |
|
 |
| |
 |
|
|
