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18-MARCH-2008  BASHAR AHMAD JABER 32 YEARS  EXTRUDED DISC c3-4 WITH CENTRAL SPINAL CORD COMPRESSION.

Anamnesis:

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The patient came to the clinic 16-February-2008 complaining of neck pain right side. He had residual after RTA 1987 with traction injury of the right C7 root, which was compensated with mild to moderate atrophy of the muscles of the right hand and hypalgesia of the ulnar distribution.

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MRI done 14-February-2008 showing PCD C3-4, central more to the left and pseudocele right C7 root.

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On examination: the power of both deltoids and biceps brachii and triceps are 5/5 with the mentioned previous deficit, which is related to the previous accident.

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The patient was advised to undergo conservative treatment with collar.

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The patient was admitted elsewhere and traction was applied to him, after what exacerbation of the pain and deterioration of his condition took place. He came to the clinic 12-March-2008 with agonizing pain and weak right deltoid and biceps brachii.

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MRI cervical spine done 15-March-2008 showed enlargement of the extrusion and malacia of the spinal cord.

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Under image-intensifier the C3-4 level was identified and anterior discectomy of C3-4 was performed. All the old and recent compressing elements were removed.

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Routine closure of the wound with smooth postoperative recovery.

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The pain in both shoulders and the power of the proximal muscles of the right upper limb returned to normal.

Comments

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The first visit was planned to undergo conservative treatment, with the hope that the extrusion could shrink by time.

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When extrusion is compressing the spinal cord, it is not wise to perform traction, since this could lead to catastrophic  and sometimes irreversible events.

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The longus colli muscles where very medially located at the C3-4 level, that it was impossible to detect them by the usual dissection methods. It was necessary to use the image-intensifier to find not only the level in lateral view, but also the AP view to identify the midline.

 

 


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