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.
