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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.

 

 
 
 
 

5. 05-APRIL-2007  RAJAA MUHAMED TBESHAT  37 YEARS  FAR LATERAL EXTRUSION OF L5-S1 DISC RIGHT FORAMINAL  COMPRESSION.

 
 

 
 

Anamnesis

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The patient came to the clinic 19-February-2007 complaining of LBP for 15 years  with right sciatica. Exacerbation of the LBP with left sciatica the last 7 months without numbness.

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MRI lumbar spine done 17-July-2006 showing assimilation of L4 and L5  and D11 and D12 with bulge L5-S1.

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On examination: The patient had scoliotic stance. SLRS was 90 degrees in both sides with pain in the right. There was no sensory or motor deficit.

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The patient then progressed severe agonizing right sided sciatica the last 10 days , for what MRI was repeated and showed extrusion of the L5-S1 disc with migration to the right S1 root foramen with severe compression.

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The patient came to the emergency of Al-Shmaisani hospital 04-April-2007 with agonizing pain and drop right foot with severe weak planterflexion right foot.

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Right L5-S1 hemiflavotomy with left S1 and L5 roots foraminotomy was performed. The extruded disc was was migrating upward and compressing the right L5 root, which was unusual, because she had several abnormalities, making image intensifier  a  must, so as to understand the presence and location of the foramina.

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The far-lateral extrusion was removed in piece-meal fashion and the right L5 root was inspected and all the compressing elements were eliminated.

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

Comments:

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The patient had an abnormal anatomy, making the use of image-intensifier a needed procedure to know exactly what to do. Using the bony guides, were useless in this case.

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The extruded disc was migrating upward and the compression was directed to the right L5 root, which is unusual. The distance between the L5-S1 annulus fibrosis and the running L5 root was minimal, causing misunderstanding of the anatomical relationships.

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 Presence of such extrusion with complete occlusion of the foramen caused severe compression of the right L5 root, which made it necessary to undergo surgery.

 

 
     
 

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