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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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8. 26-MAY-2007 INTISAR AHMAD GHOUSHEH 52 YEARS
EPIDURAL GRANULOMATOUS MASS COMPRESSING THE SPINAL
CORD AT D6 AND D7 LEVELS.
Anamnesis
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The patient came to the
clinic 21-May-2007 complaining of right
intrascapular region 40 days ago with
edema of the right lower limb and
inability to walk the last 13 days.
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MRI of the lumbar spine was
performed 17-May-2007 showing PLD L4-5 and L5-S1
with first degree spondylolisthesis. |
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The patient is a known
hypertensive with recently recognized diabetes
mellitus. |
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The patient is wheel chaired
and cannot stand for Romberg or scoliotic stance
assessment. |
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The abdominal reflexes were
absent both sides with SLRS 20 degrees in
the right due to weakness and the left 60
degrees. Sensation was intact, but the patient
claim numbness both lower limbs. There is gross
weak all muscles both lower limbs more
pronounced in the right side including the
quadriceps muscles. |
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MRI of the dorsal spine was
requested and a huge extramedullary mass
was compressing the spinal cord at the D6-7
levels. It was reported to be a meningioma. |
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There was a discussion with
relatives that the histological verification is
hard to tell even during the surgery, and they
were told that tbc could have place and the
final result will be after the surgery. |
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Laminectomy of D6 and 7 was
performed. The epidural fat was granulomatous
and thick with loculations, some of them
containing pus. The pus was sent for CXS and the
mass was resected completely. It was adherent to
the dura, but it was separable. |
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Inspection of the dura for a
mass intradural was negative. This was done by
finger palpation. The dura was not open
intentionally to avoid dissemination of the
pathologic material intradurally. |
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Routine closure of the wound
with smooth postoperative recovery. |
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The blood sent for tbc IgG
which was very high confirming that the lesion
was tuberculous granulomatous epiduritis. |
Comments:
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This is another example of
tbc of the spine, which could mimic any
pathologic process. |
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As seen in the left side of
this window, the news section, where
08-March-2007 there was a n announcement that
tbc of the spine is gaining a new clinical
picture and is increasing in frequency. |
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