The patient was admitted to Al-Shmaisani hospital 15-May-1999 with clinical picture of complete paraplegia with anesthesia below Th 11 level in wheelchair, complaining of back pain with distorted alignment of the spine.

The patient suffered RTA 6 months ago and was treated locally by fixing his spine using Hartchell rectangles and was trained to pass urine by catheter and defecate with laxatives.

The patient was investigated  and CT-scan  and routine DL X-rays demonstrated unacceptable deformity of of the fracture site  with dislocated fragmented body of L1. The device was loose and the sublaminar wires were displaced at the superior part of the construct.

 Considering these data, the patient was operated 15-May-1999: removal of the loose construct was done. Two days later MRI of the dorso-lumbar spine done showing severe compression of the spinal cord  with practical cut of the spinal cord at the L1 level.

The patient was operated 01-June-1999: using the high speed drilling and Acromed transpedicular screws, practical coporectomy of L1 with discectomy of D12-L1 was performed and fixation of L2 and D12  was achieved. The dura was decompressed and it was not violated.

Postoperative course was uneventful.

It was proposed to the patient that he could benefit from cross anastamosis of the dorsal roots to be transferred to the lumbo-sacral roots since 2004, but he was reluctant.  He sought every type of therapy all around the world and his condition, remained the same.

The patient then came 23-December-2007 asking for such surgery. It was explained to him the pros and cons of such surgery and he agreed upon.

Considering that such surgery is a long procedure it was decided to divide it in to 2 stages.

21-January-2008: The saphenous nerves with its both divisions at the knee level were harvested with the patient in the supine position. The sural nerves with their lower divisions were harvested from both legs in the prone position. The sensory femoral nerves, running medial to the sciatic nerves were harvested with their perianal and descending cutaneous nerve were harvested from both sides.

This procedure took 14 hours length and the patient was awaken and sent to the ICU.

To continue with the next part, click here!