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.
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.
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.
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.
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.