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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. 25JANUARY-2007
IBRAHEEM AHMAD DAWOOD 44 YEARS EXTRUDED DISC
L5-S1 LEFT DOWNWARD MIGRATION.
Anamnesis
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The patient came
to the clinic 22-December-2007 complaining of
LBP for 2 years. Exacerbation of left sciatica
the last 11 days down to left L5 root territory
and positive cough sign. |
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MRI of bad quality performed
11-July-2004 showed extruded disc L4-5 with left
upward migration. |
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The patient is limping with
exaggerated scoliotic stance with SLRS 45
degrees in the right and 30 degrees in the left
with hypalgesia left L4 and L5 territories and
almost drop left foot. |
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The patient was sent for new
MRI, which showed left L5-S1 disc extrusion with
downward migration. |
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Left S1 foraminotomy was
performed and left L5-S1 hemiflavotomy was
achieved. The extrusion was removed from under
the axilla. Minimal cleaning of the disc pace
was performed from the left side. |
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Smooth postoperative
recovery. |
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, but here the disc
material was looking healthy, for what minimal
cleaning was limited. |
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The epidural fat was
acceptable and was kept and preserved until the
end of the operation. |
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The disc space of this
patient is not narrow and the cleaning was
performed minimally and the defect in the
annulus fibrosis was minimal, which could
predict an estimated incidence of 7% recurrence rate.
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All the time, do not hesitate
to ask for new MRI, if the previously performed
MRI is of bad quality or an old one. The
morphologic data could be different and mistakes
could be avoided by following such policy. |
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