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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

 

The patient  came  directly to the hospital with clinical history of complete paraplegia below L3 level for 3 weeks. He had previous attacks of LBP for several years and he underwent excision of sacral coccyadenitis 7 months ago.

MRI performed showing severe LCS L3-4 L4-5 and extruded disc L3-4 with tethered cord syndrome. The patient had complete loss of sensation of the left foot with hypalgesia of the other below knee with the paralysis complete in the right more than the left, resembling Brown-Sequard syndrome, but complete drop both feet and qauda equina syndrome is the main clinical picture. He had micturition problems 3 weeks ago, with slight improvement.

The patient underwent surgical decompression of L3-4 laminae and the upper sacrum, which in reality is the L5 lamina. Removal of the L3-4 disc extrusion was performed from the right and inspected from the left. Foraminotomy of both L4, L5 roots was performed. Considering that the filum terminale regained at least 5 mm relaxity after the decompression and annulation of the angulation, it was decided not to untether the cord, since he is 38 years age and he never complained of it previously.

Routine closure.

The patient came to the clinic 19-February-2006. The wound was clean and the hypalgesia was restricted to the left L5 root territory with regaining full power of the right foot and the power of the left foot planterflexion was 4/5, but still drop left foot. Urination and defecation were normal and he can walk with aid of one person.

Comments:

It is rare to see such a case with all these data gathered to cause paraplegia. It was decided before the surgery to perform untethering, but after achieving decompression, this plan was omitted, because of his age and the extra-relaxation of the cord obtained by eliminating the angulation at this area.

 

 

 

 

 

 

 

 

 


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved