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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

 
 - Part 6

The operation took 20 hours and the patient received 4 units of packed cells and FFP and kept in the ICU for 6 hours. The patient was covered by targocid 400 mg daily and pain-killers. The ready-vac drain was removed after 24 hours and dressing of the spine was performed for 4 days, till it became clean. He was able to set on the wheelchair in the 5th postoperative day.

20-January-2006: The patient and wife noticed that all the mass reflexes, which caused problem to the patient before the operation disappeared. This is mostly due to isolation of the preganglionic part of the lumbar nerves. No deterioration in his bowel and bladder functions were noted.

In my opinion, this fact making the operation giving advantage, even in the early postoperative period, manifesting the disappearance of the negative phenomena of the destroyed spinal cord.

Comments:

1. this is the third performed operation, and with the increased number of the operations  and with time and end results will be clear. The first performed operation was in 28-January-2004 which gave partial but excellent results concerning the anastamosed nerves. He could show the improvement of some muscles and sensation of some roots, but the operation was not organized enough to make him able to walk, due to several factors, among them the negligence of the patient for his situation and disappearance of the patient mostly due to financial reasons. He came only once to me 18 months after the surgery and I was astonished with the good reinnervation of the grafted nerves.

2. The surgical standards are becoming more standardized and the steps of the operation becoming more precise. The maximal 8 grafts harvested govern the limitations of the operation and the number of the lost grafts in the patient also play a major impact in the decision-making.

3. This operation can be applied not only to paraplegics, but also to stationary post-transverse myelitis and other conditions, where the certain roots for good lost their function.

4. The fact that the dorsal roots supply relatively small segments of dermo-myotoms make some skepticism about the final result of the operation and the presence of 2 stitching points to fill the gap and the sensory nature of the grafted neural material, all play  a negative theoretical role in the outcome. Time will tell.

Follow Up:

1. The patient came 26-July-2006 to the clinic. On examination, the patient still with spastic pattern of both lower limbs with condom. There is still no signs of motor recovery, but the crude sensation step downward to the level of the umbilicus. The surprising thing is that the sacrificed dorsal roots all returned their function. ( 10% of each root left in continuity during the procedure, so as to prevent slippage of the roots and to ease the insertion of the anastamosis, as used with the partial resection of the hypoglossal nerve in cross anastamosis for the facial nerve.

2. The patient was told to press his thoracic cage to stimulate the lower limb movement and continue physiotherapy and given medications to be reevaluated after 6 months.

3. Cross-anastamosis in paraplegia below D9 started to give results. The patient operated 1 year ago from Israel came  27-December-2006 to the clinic. ECS and EMG performed showed that there is starting innervation of Th 11 and 12. The patient 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.

 


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