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The group in action.

 
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

 
17-JUNE-2006 MUHIYE-EDDIN HASAN MUHAMED JABER 60 YEARS SEVERE CCS WITH SCOLIOTIC DEFORMITY WITH QUADRPLEGIA DUE TO SPASMODIC TORTICOLLIS.
The patient came to the operating room with quadriplegia below C4 with mild movement of the right deltoid and biceps brachii mm.  Complete anesthesia was noted at the same level.  The condition started to deteriorate the last 2 months and he was bedridden for 45 days. The patient has spasmodic torticollis, with turning the head to right and up. He could have dystonia musculorum deformans, but due to quadriplegia it is hard to tell and the possibility of Tourette's syndrome must be in the differential diagnosis.

Considering the rapid deterioration and the MRI findings of severe CCS with secondary cervical scoliotic deformity, the patient was sent to the operating room. In the laminectomy position laminectomy of C3-5 was performed. The severe bony compression was removed at the C3-4 right side at the last stage, where maximal compression was noticed. It was noticed that the lateral mass of C3 in the right side was shifted anteriorly. Using lateral mass screws rigid fixation of c3 to C6 was performed after correction of the scoliosis by distraction. The upper part of the rod was intentionally positioned, so that some fixation of C2 was achieved, and to bring the shifted anteriorly lateral mass of C3 backward. The gap between the facets in the right side was filled with chips of bone.

Considering that the patient could have spasmodic torticollis, Bertrand procedure with neuroectomy of the posterior motor branches of C3-5 was performed from both sides.

Bridge was applied to the construct to aid more stability. Routine closure and smooth postoperative recovery. Slight improvement of the right upper limb with the left deltoid start to function. Some movements of the left lower limb start to be noticed. The jerky movements decreased in intensity.


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