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Dr. Ali Al-Bayati

 
Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

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04-JULY-2011 RUQAYA MUHAMED ALI  65 YEARS NEGLECTED UNSTABLE FRACTURE L2 WITH SUBSEQUENT INFECTION OF L2 AND LEFT PSOAS MUSCLE.

Anamnesis

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The patient came from Yemen to the clinic 19-June-2011 complaining of agonizing LBP with bilateral sciatica for 2 months after falling down with inability to walk or set.

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MRI lumbar spine done 14-May-2011 showing fracture L2 with collection of the left iliopsoas muscle. MRI repeated 04-June-2011 showing the same picture.

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On examination: the patient is walking with the help of two persons. It was impossible to evaluate the scoliotic stance. She was crying during examination due to pain in the lower back. SLRS was 25 degrees in the right side and 30 degrees in the left. There is weak dorsiflexion right foot -4/5.

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CT-scan of L1-L3 performed 20-June-2011 showing burst fracture of L2 with bony compression in the lumbar canal. 

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Septic workup was performed and the WBC was 18.000, ESR 24 and CRP was 40. The CXS for Bac-tec was negative for 6 days. The patient had no fever, but was empirically covered with Avoxin 750 mg and Zinnat 500 twice daily.  She was held in antibiotics for 2 weeks.

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MRI lumbar spine was repeated 03-July-2011 and the data were the same as before. The WBC became 11.000, CRP 24 and ESR became 40 mm/h.                               

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Skeletonization of L1-2-3 with preservation of the intraspinous ligament. Zimmer Java monoaxial pedicle screw  45x6.5 mm was inserted from the right and 40x6.5 mm from the left of L1 vertebra. Two monoaxial 40x6.5 mm transpedicular screws were inserted to L3 body. Using left transpedicular approach, the body of L2 was inspected and fragments were sent for another CXS and tbc studies. There was no pus, nor active inflammatory process in the area. The empty cavity of L2 was impacted with Novabone 5 cc. Using 90 mm length rods fixation with reduction after distraction was applied to the area. Transverse connector was applied. The patient was covered with Targocid.

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Routine closure of the wound.  All the stages of surgery were performed with image-intensifier.


Postoperative Course:

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The patient could walk with pain in the 2-d postoperative day and the right sciatica  disappeared. The left psoas muscle which is affected by the inflammatory process still causing pain in the left iliopsoas region. It was explained to the patient and family, that the infection will take several months to resolve with the cover of antibiotics.

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The tbc result was negative and the CXS results still without growth.

 

 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The white signal in the body of L2 and left psoas muscle were seen the next day after trauma and in all MRIs over the 45 days.

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Infection must be considered and the patient must be treated as, even if the laboratory studies were negative all the time.

 


Postoperative X-ray done 08-July-2011 showing acceptable alignment.

 

 

 

 


Back Up!

Notice: Not all operative activities can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also escaped from the plan .

 

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