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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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10. 17-APRIL-2007 RAWAN
ABU-THABET 24 YEARS MALFUNCTIONING
VENTRICULO-PERITONEAL SHUNT.
Anamnesis
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The patient came to the
clinic 01-March-2007 complaining of LBP for
15 years. Exacerbation of right sciatica the
last 2 months. |
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MRI lumbar spine done
12-February-2007 showing small extrusion L5-S1
right side. MRI done 11-December-2005 showed at
that time a huge extrusion L5-S1. |
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The patient was given the
opportunity to try conservative treatment, and she came
17-March-2007 confirming that here
condition is improving. |
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On examination: The patient
had scoliotic stance. She had SLRS 70 degrees
in the right with shooting sciatica right side.
She
had severe weak dorsi and planterflexion right
foot and hypalgesia right S1 root territory. |
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The patient then came asking
for urgent surgery, because her condition is
deteriorating. |
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Right S1 foraminotomy was
done with partial right sided flavotomy and the
swollen root was inspected and the extruded disc
L5-S1 was removed lateral to the axilla. All the
fresh and old fragments of the extrusion were
removed. Meticulous cleaning of the disc space
was performed. It was clear, that the extrusion
was old and part of it was adherent to the root,
for what it was dissected of the root. The
congestion decreased and the foramen was checked
for patency. |
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There was no sufficient epidural fat to
transfer, then the most near fat was transferred
to cover the roots to minimize
postoperative scar formation. |
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Smooth postoperative recovery
and normalization of the power of right foot. |
Comments:
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The patient in the first
visit was in clinical status, that surgery could
be avoided, for what surgical treatment was not
decided at that time. |
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The deteriorating clinical
picture made it clear that surgery is indicated. |
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The patient had a protracted
course with long history, that the root was
adherent to the extrusion. |
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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 pain in the long run, but
when it is not available, then transferring the
most near fat is the next alternative. |
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