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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-4

The length of the grafts must be measured carefully and the gaps between the intended to anastamose the roots above and below the lesion must be also measured. This must performed, so as to put the grafts with laxity, so as to avoid disruption in case that the patient bend the spine after the operation.

In this case the anterior cutaneous femoral graft was used to bridge the D9 to L1 root in both sides. The saphenous graft was used to fill the gap between D8 and L2 and the sural graft between D7 and L3 subsequently. The branching part of the saphenous nerve was removed from the graft to have more perfect structure for anatomizing.

 


Notice:

In this case only the L1-2-3 postganglionic roots were anastamosed with D9-8-7 sequentially. The patient will regain  hip flexion, knee flexion and extension, but the muscles of the feet will regain nothing. This is theoretically speaking, but the patient could have anatomical variation and time will show that. Since the anastamosis is located in the root level, some bridging could reach the sacral plexus and some improvement could be noticed in the future.

For these reasons, and considering that the principle of not causing harm to the patient , the major important nerves of the legs were excluded as donors.


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