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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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4. 24-JANUARY-2007
MUHAMED SALEEM SALEH 54 YEARS EXTRUDED DISC
L4-5 WITH RIGHT DOWNWARD MIGRATION - DIABETES MELLITUS.
Anamnesis
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The patient came
to the clinic 07-December-2004 complaining of
LBP for 4 years with right sciatica. The patient
is a known diabetic for 9 years. The patient is
left handed with Hoffmann positive in the right
with weak grip and extension of the right hand
and right triceps muscle. The patient was
limping and with SLRS 45 degrees in the right
with weak right foot. MRI of the brain, cervical
and lumbar spine were requested, but the patient
escaped. |
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The patient then came to the
emergency of Al-Shmaisani hospital
19-January-2007 with agonizing right sciatica.
He had exacerbation of right sciatica the last 3
months. He was unable to sleep the last week.
MRI of the lumbar spine was requested and done
21-January-2007, showing a huge extrusion of
L4-5 disc with right downward migration. |
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On examination, the patient
was unable to walk and drop right foot with
hypalgesia of the right L5,S1 roots. |
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Right L5 foraminotomy with
right L4-5 hemiflavotomy was performed and the
downward migrating disc was removed from under
the axilla in several pieces. The root became
free, but it is swollen. |
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The root was shifted medially
and the the disc space was cleaned from the
sequestrated intradiscal material. Moderate
amount was removed. |
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The epidural fat was shifted
to cover the root, to minimize the scar
formation. |
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Smooth postoperative recovery
and the power of the right foot became normal. |
Comments:
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Minimal cleaning of the
intradiscal space proved to heighten the
incidence of recurrence, so that, it is
preferable to perform intradiscal cleaning of
the sequestered material inside the disc space,
after removing the extrusion. |
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Epidural fat local transfer
is the best solution to prevent scar formation
at the root trajectory. This maneuver decrease
the postoperative pain suffering. |
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The disc space of this
patient is not narrow and the cleaning was
performed moderately and the defect in the
annulus fibrosis was minimal, which could
predict a lower than 7% recurrence rate.
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