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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

 
16-AUGUST-2006  SALEH SA'ED NASER  56 YEARS  DORSAL CANAL STENOSIS AT D10-11 LEVEL WITH PARAPARESIS BELOW THIS LEVEL.
The patient came 13-August-2006 complaining of LBP for 2 years  with bilateral sciatica. He is using crutches after surgery for PLD  1 year ago  and 8 months ago for redo. MRI done 25-November-2005 showing status after discectomy of L4-5 and L5-S1.

On examination: SLRS was 80 degrees both sides with absent knee and Achill's reflexes with Babinski both sides  with weak right quadriceps 4/5 and both knees abduction and adduction 4/5  and dorsi and planterflexion both feet 4/5  both with hypalgesia right lower limb up to the knee level.

Considering that the discrepancy of the neural involvement, MRI of the dorsal and lumbar spine were requested and done. At the previous operated site there are a lot of adhesions, but no recurrence was noted. At the level of D10-11 there is dorsal canal stenosis with malacia of the spinal cord at that level.

Using image intensifier, decompressive laminectomy of D10 and D11 was performed with drilling of hypertrophied facets, which were kissing each other with absent epidural fat was noted.  Complete decompression was done and during the last steps of decompression partial avulsion of the left Th10 accidentally took place by the Smith-Kerrison tip with subsequent dural tear, which was repaired with nylon 6 zero. Check for CSF leak was negative. Routine closure of the wound.

Prompt postoperative recovery and immediate normalization of the power of both lower limbs.

Comments:

1. Dorsal canal stenosis is rare in occurrence, but it strongly resemble the process taking place in the lumbar area. There is difference in that, there is no bony compression as in the lumbar area, but the hypertrophied ossified facets are the main cause for stenosis. The PLL play no role in this area as in the cervical spine.


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