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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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5.
16-MAY-2007 MAHA ATTA MUSTAFA RAMADAN 42
YEARS PARAPLEGIA BELOW L1 DUE TO EXTRUDED DISC
L1-2 WITH SEVERE SEGMENTAL STENOSIS AT THIS LEVEL.
IATROGENIC INSTABILITY OF L4-5 AFTER 2 SURGERIES FOR
LOWER LUMBAR SPINE.
Anamnesis
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The patient came to the
clinic 12-May-2007 in wheelchair complaining of
complete paraplegia below L1 level with loss of
micturition and defecation control. |
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The patient underwent surgery
for PLD L4-5 1996 for left sciatica. The patient
then was operated 20-February-2007 for the
"recurrence". |
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On examination: the patient
had profound weak both quadriceps muscles 1/5,
abduction and adduction of the knees 0/5 and the
dorsi and planterflexion both feet is 0/5. She
has no sensation for micturition and defecation. |
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MRI lumbar spine performed
25-April-2007 showing severe stenosis L1-2 with
extruded disc obliterating the space more from
the left, with spondylolisthesis L4-5 due to
absence of the isthmi of L4-5 both sides. |
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Decompressive laminectomy of
L1 and L2 was performed, using drilling to
prevent surgical trauma to the spinal cord. The
isthmi are very close to the midline.
Considering that, foraminotomy of left L2 root
was performed without violating the stability of
the region. The extruded disc was removed from
the left side lateral to the axilla. Meticulous
cleaning of the disc space of L1-2 disc space
from the left. |
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Under the image intensifier
the remnants of the L4 and L5 were identified
and transpedicular screw fixation with reduction
and distraction was performed between L4 and L5
bodies. Bone graft was inserted between the
lateral processii of L4 and L5. Routine closure
of the wound. |
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Smooth postoperative
recovery. |
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The patient showed mild
improvement of the quadriceps and abduction and
adduction of the knees immediately after the
operation and start to feel pain in the right
lower limb. |
Comments:
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Removal of the isthmi could
cause segmental instability, as in this case.
The patient was not complaining about this
instability, because, she was paraplegic below
L1 level. This problem will show up in case of
improvement of the neurological status after
surgery. So as to avoid this future situation,
transpedicular screw fixation and reduction was
performed. |
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Careful neurologic
evaluation, must be performed to avoid mistakes
in decision making and planning for surgery. The
patients main problem was at the level of L1-2.
Despite this fact, the patient was sent to
perform MRI of the dorsal spine, so as not
perform another mistake. |
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