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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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12. 30-DECEMBER-2007 ABIDAT SALEH LAMBAZ
44 YEARS SPONDYLOLISTHESIS L4-5 WITH AGONIZING RIGHT
SCIATICA.
Anamnesis
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The patient came to the
clinic 30-June-2007 complaining of LBP with
right sciatica for 1 year with exacerbation the
last 5 months. |
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MRI done 01-April-2007 showed an extruded
spondylolisthesis L4-5 I-II degrees. |
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On examination: the patient had weak
dorsiflexion right foot 4/5
with scoliotic stance and SLRS 80 degrees both
sides with hypalgesia right L5 territory. |
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The patient was advised to
undergo conservative treatment and further
studies were planned and performed. |
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The patient then came
14-November-2007 with deterioration of her
status with hypalgesia of both L5 and S1 roots
right side. |
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Another MRI was performed
01-December-2007 showing escalation of the
spondylolisthesis with isthmolysis. |
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Laminectomy of L4 was
performed and foraminotomy of both L4 and L5
roots was done both sides. All the compressive
elements was removed. The right isthmus was
fractured. The right L4 root was running
perpendicular in relation to the cul de sac. |
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Using ISIS Inomed Highline
IOM with pedicular screw scenario, the roots at
the start of the operation could be triggered
with 0.8-1.4 mA, but later after 20-30 min this
was achieved with 4-6 mA. |
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Using image-intensifier the
screws were inserted to the L3 and L5 pedicles
both sides, during that the EMG recording did
not show any sustained activity. Using up to 30
mA the screws did not show any EMG response,
confirming that the neural structures are not in
contact with the screws. SEP was running in
acceptable manner. |
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Inspection of the L4-5 disc
showed that it was glistening and it was left
without violation. |
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Using bended rods and bridge,
fusion was achieved between L3 and L5 bodies. |
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The bone chips harvested from
the spinous processii were milled and inserted
lateral to the construct. |
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Routine closure of the wound
and smooth postoperative
recovery. |
Comments:
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The use of the IOM for
transpedicular screws is a good practice, but
considering that the exposed roots already in
the field make this maneuver illogic. This
technic has its merits. It could confirm that
the far running roots outside the field are not
violated and the upper screws also not in
contact with roots and no break was having
place. |
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At the end of the operation,
the probe could not trigger the roots even with
high currents even with 29 mA. This could be a
fault of the technology, which start to
troubleshoot after 2-3 hours. The operation took
place 7 hours. Most of the time trying to know
what problem with the ISIS machine. Such an
operation take usually 3-4 hours at maximum. |
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