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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.

 

 
 
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04.  04-DECEMBER-2007  HANAN MUHAMED HASAN  33 YEARS  HUGE EXTRUDED AND SEQUESTRATED DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.

 

 
 

Anamnesis

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The patient came to the clinic 03-December-2007 complaining of LBP with right sciatica for 18 months. Exacerbation of the right sciatica the last 5 days with numbness of the S1 territory.

MRI performed 02-December-2007 showing huge extruded and sequestrated disc L5-S1 right side with a huge fragment separated from the disc material travelling down.

On examination: the patient limping with mild scoliotic stance, with agonizing sciatica. SLRS was 20 degrees in the right with almost drop right foot and weak planterflexion right foot 4/5. There was hypalgesia of the right S1 territory.

The patient asked for small incision, for what 35 mm length incision was made and right L5-S1 hemiflavotomy with right S1 root foraminotomy was performed. The upper part of the extrusion was removed and cleaning of the disc space was performed from the right. The separated piece was explored and it was found 10 mm below the disc space pushing the S1 root medially. It was exposed and a huge big piece was removed in one piece.

The epidural fat was transferred to cover the right S1 root.

Smooth postoperative recovery.

Comments:

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The patient asked for small incision. It means, that during flavotomy it is necessary to use the loupes with magnification to see exactly what is going on and to perform the usual tasks.

The neurosurgeon must be a good MRI reader so as not to miss the separated piece. Foraminotomy was extended more than usual so as not to escape such far migrating piece..

 
     
 

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