Neurosurgery.tv Home Search neurosurgery.tv drelias@go.com.jo
Home
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
 

RELATED WEBSITES

neurosurgery.fr neurosurgery.guru
neurosurgery.me
microneuroanatomy.com
ioperativemonitoring.com
diencephalon.info
mesencephalon.org
medullaoblongata.info neurophysiology.ws
humanneurophysiology.com
e-neuroradiology.com
onconeurosurgery.com
schwannomas.com
acousticschwannoma.com
pituitaryadenoma.net
meningiomas.org
craniopharyngiomas.com
craniopharyngiomas.net
pinealomas.com
glioma.ws
ependymoma.info
spinesurgeries.org
spondylolisthesis.info
paraplegia.co
vascularneurosurgery.org
Neurosurgical Encyclopedia
cns-clinic.net
munir.ws

 
 
 
 

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.

 

 
 
 
 

04.  04-NOVEMBER-2007  SUAD ABDEL-NABI KHALEEL  45 YEARS  LCS L3-4, L4-5 AND OLD PLD L5-S1 RIGHT SIDE WITH I-DEGREE SPONDYLOLISTHESIS L4-5

 

 
 

Anamnesis

bullet

The patient came to the clinic 20-October-2007 complaining of LBP with left sciatica for 2 years after falling down. Right sciatica took place the last 3 weeks after the mother death.

bullet

MRI lumbar spine done 04-July-2007 showing LCS L3-4, L4-5 and L5-S1 with spondylolisthesis of L4-5 and extrusion of L5-S1 right side.

bullet

On examination: the patient has scoliotic stance with weak dorsi and planterflexion both feet. SLRS was 90 degrees both sides.

bullet

The patient was sent for another MRI with MRMyelography of the lumbar spine with dynamic X-ray studies. The same findings were observed and about the overmobility of the L4-5 was not conclusive.

bullet

It was explained to the patient and relatives, that the patient needs decompression of the stenosed segments and exploration of the overmobility will be studied during surgery.

bullet

Skeletonization of L3 down to the sacrum was performed after putting the patient in ISIS Inomed IOM using pedicle screw scenario.

bullet

Check for instability of L4-5 was not convincing. Decompressive laminectomy of L4, L5 and partial of L3 and upper rim of the sacrum was performed. The dura was very thin due to severe compression all over the field. Foraminotomy of right S1 root was done and there was a small tear below the axilla due to severe compression, which was stitched using nylon 6 zero.  Check for segmental instability was performed several times and inspection of the L4-5 isthmi and the facet joints applying considerable amount of force denied the presence of instability.

bullet

During the foraminotomies, using MEP protocol, the stimulation threshold of the running roots were ranging from 3-4 mA.

bullet

Inspection of the L5-S1 extrusion showed that it is very hard and not movable, for what it was decided not to remove the extrusion, nor to use the transpedicular screws for fixation.

bullet

Smooth postoperative recovery with normalization of the power of the right foot.

Comments:

bullet

The presence of I-degree of spondylolisthesis is not sufficient to go for transpedicular fixation. Staged check for instability, must be performed in all steps of surgery. If there is suspicion about instability take place, then transpedicular screw fixation is mandatory. Otherwise it is better not to fuse the stable structure.

bullet

The presence of ossified extrusion at L5-S1 made it reasonable not to touch the extrusion, since foraminotomy of the right S1 root was sufficient to resolve the problem and in case of disc removal another possibility for recurrence will emerge later.

 
     
 

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