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NEWS

January/06/2007

Surgical treatment in paraplegia survey:

Cross-anastamosis in paraplegia below D9 started to give results. The last documented case operated 1 year ago in a patient from Israel came to the clinic 3 weeks ago. ECS and EMG performed showed that there is starting innervation of Th 11 and 12. The patient's lower limbs muscles became bulky and he could contract the lower abdominal muscles and some movements in the pelvic girdle. Crude sensation descended down to the inguinal level both sides. If you are more interested in this topic, click here! 

March/08/2007

Tuberculosis of the spine

In the last 2 years the incidence of tuberculosis of the spinal column is becoming more frequent and having different clinico-morphologic picture. This phenomenon is alarming sign as the residual of the use of dirty bombs and several radioactive materials in the surrounding dirty wars in the region. For demonstration click here! and here!

20-AUGUST-2007

SIEMENS Digital C-arm is implemented and functioning in the Shmaisani hospital.

30-AUGUST-2007

The Inomed ISIS Highline neurophysiologic navigation system start to work at the operating room.

28-November-2013

Magnetom Skyra 3 tesla with all clinical applications start to run.

 

 
 
 
 

3. 01-APRIL-2007  UTHMAN TAHER AL-WAZEER  35 YEARS  EXTRUDED DISC L5-S1 WITH LEFT DOWNWARD MIGRATION.

 
 

 
 

Anamnesis

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The patient came from YAR to the clinic 31-March-2007 complaining of agonizing left sciatica for 2 months with escalation the last week and numbness of the left L5 and S1 roots territory.

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The patient was operated 25 years ago for PLD L4-5 in UK.

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MRI of the lumbar spine performed 24-March-2007 showing extruded disc L5-S1 with no recurrence at L4-5 level. The MRI was of bad quality.

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On examination: the patient walking with aid and crutches. The patient is limping and has scoliotic stance. SLRS was 35 degrees in the right and 5 degrees in the left. The left AJ is absent in the left with analgesia for pin-brick at the left S1 root territory and hypalgesia of the L5 territory. There is weak dorsiflexion left foot 4/5.

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The patient was sent for new MRI of the lumbar spine, which was performed and more clearly demonstrated the extrusion and the left side downward migration of the piece.

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Left L5-S1 hemiflavotomy with left S1 foraminotomy was performed. The root was severely compressed from anterior and it was necessary to perform discectomy of L5-S1  to regain some ample and to withdraw the extrusion back to the disc space cavity, after what it was possible to remove the extrusion in one piece lateral to the axilla.

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Further cleaning of the disc space was performed from the left side. The root regained relaxed position. Routine closure.

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Smooth postoperative recovery and normalization of the power of the left foot.

Comments:

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The extruded disc was not large enough, but the root was severely compressed by the extruded and downward migrating piece, causing complete loss of the function of the left S1 root.

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So as to avoid surgical trauma to the already traumatized root, it was necessary to decompress the disc material, then the extrusion was removed, after pushing it inside the disc space. Avoidance of surgical trauma to the neural structures, make postoperative deterioration of them a rarity.

 

 
     
 

Copyright [2007] [CNS Clinic]. All rights reserved