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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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08.
16-AUGUST-2007 SARA MUHAMED AHMAD 47 YEARS
HUGE EXTRUDED DISC D12-L1 LEFT SIDE.
Anamnesis
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The patient came to the
clinic 08-July-2001 complaining of LBP for 17
years with left sciatica. MRI performed
23-June-2001 showed extruded disc D12-L1. |
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On examination at that time
SLRS was 60 degrees left side, hypalgesia all
the left lower limb below the inguinal line with
with weak dorsiflexion all toes left foot
and the left quadriceps. The patient was advised
to undergo surgery and she disappeared. |
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The patient came
05-August-2007 with the same clinical
manifestations with incontinence for 1
year with SLRS 10 degrees in the left
and 40 degrees in the right. The weak
dorsiflexion all toes increased and there is
also weak planterflexion all toes left foot. |
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The patient sent for another
MRI and it was performed 09-August-2007 showing
the same extrusion and small bulge disc L4-5 |
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Left D12-L1 hemiflavotomy was
performed guided with fluoroscopy and the
the lateral edge of the isthmus was very medial,
that only 5 mm was possible to preserve to reach
the lateral edge of the dura. The extruded disc
was removed in piecemeal fashion and the root
was so adherent, that a small tear in the root
lateral to the axilla was noted.
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After meticulous cleaning of
the extruded disc and left sided cleaning of the
space, the dural tear was repaired by nylon 6
zero. |
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Smooth postoperative recovery
and normalization of the power of the left
lower limb. |
Comments:
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The patient escaped for more
than 7 years and the problem never resolved and
her clinical picture became worse. This fact
made the dura adherent to the extrusion and the
tear was the natural subsequent problem, which
could take place. |
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The extruded disc material
remained soft, which is unusual in this
protracted period of time. |
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