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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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7.
27-JANUARY-2007 MAWLOOD UMAR BOUR 75
YEARS LCS L3-4. L4-5 WITH LATERAL RECESS SYNDROME
AND DROP RIGHT FOOT.
Anamnesis
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The patient came to the
clinic 13-January-2007 complaining of LBP
with shooting right sciatica and inability to
walk the last week. Mild LBP had for 2 months.
MRI performed 10-January-2007 showing LCS L3-4
and L4-5. |
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On examination: the patient
was unable to stand to see his scoliotic stance.
SLRS was 70 degrees both sides. Sensation was
intact, but he had drop both feet with
planterflexion right foot 2/5 and 3/5 of the
left foot. Both knee abduction was 2/5 with
adduction 3/5 and quadriceps femores 4/5 both
sides. He had normal micturition and defecation. |
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The patient is a known
diabetic and hypertensive with bronchial asthma,
for what cardio consultation was asked before
the operation. |
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Decompressive laminectomy of
L3, L4 and partial of L5 was done. The epidural
fat was absent all over and the hypertrophied
ligamentum flavum was inflamed in the left side
and adherent to the dura. Using sharp
dissection, these parts were removed. |
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Foraminotomy of right L4,5
and left L4 was achieved and the the foramina
were checked for their patency.
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Inspection of L3-4 and L4-5
disci confirmed their good alignment. They were
kept intact. |
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Routine closure with smooth
postoperative recovery with normalization of the
power except the power of the right foot
dorsiflexion. |
Comments:
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The patient showed an
abnormal course of lumbar canal stenosis: short
duration and right sciatica. The weakness is
more profound, than to be explained by the
morphologic data. These hold the suspicion, that
another provocative factor playing a role. The
presence of ligamentitis of granulomatous
behavior hold suspicion about sarcoidosis or
other granulomatous disease. |
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The patient was complaining
more from the right side and the pathological
findings were in the left. This could be
explained by the tiny structures of the nerve
roots and severity of the compression. It is
hard to tell, why such discrepancies taking
place. |
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