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22-NOVEMBER-2007 Case Two |
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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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17. 22-NOVEMBER-2007
IMAD MUHAMED HABASH 36 YEARS HUGE EXTRUDED
DISC L4-5 WITH LEFT DOWNWARD MIGRATION.
Anamnesis
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The patient came to the
clinic 21-November-2007 complaining of LBP
with left sciatica for 4 months. MRI performed
19-November-2007 showing huge extruded disc L4-5
with left downward migration. |
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On examination: the patient
has exaggerated scoliotic stance, limping with
SLRS 45 degrees in the right and 20 degrees in
the left with pain. |
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He had weak dorsi and
planterflexion left foot and hypalgesia left L5
and S1 territories. |
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Left L4-5 hemiflavotomy with
left L5 root foraminotomy was performed. The
extruded fragment was completely covered by the
root and axilla, that it was impossible to
remove it from both routes. It was necessary to
decompress the disc space first, then to proceed
with piece-meal removal of the extrusion,
pulling it down to the disc space, after what
the major part of the extrusion could be caught
and removed, after what the root and the axilla
regained relaxed appearance. |
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Meticulous cleaning of the
disc space from the left. |
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Routine closure of the wound
and smooth postoperative recovery with
improvement of the power of the left foot. |
Comments:
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If the extrusion is fixed by
the root and the axilla, it is better to start
decompressing the disc space, after what the
tension over the neural structures decrease,
permitting removal of the extrusion with minimal
traction injury to the neural structures. |
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The estimated recurrence rate
in this case must be minimal, since the disc
space height is minimal. |
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