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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.

 

 
 
 
 

7.  10-APRIL-2007  HUSNIYEH NAJAH SUBHY  40 YEARS  HUGE EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION AND RECENT FRACTURE BOTH ISTHMI OF L4-5  AFTER TRADITIONAL TREATMENT.

 
 

 
 

Anamnesis

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The patient came to the clinic 08-April-2007 complaining of severe LBP with agonizing right sciatica for one month.

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MRI lumbar spine done 05-April-2007 showing huge extruded disc L4-5 with right downward migration.

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On examination: The patient could not stand for scoliotic assessment and Romberg test. She had SLRS right 40 degrees and 5 degrees in the left. She had drop left foot with weak planterflexion of the same foot with hypalgesia left L5 and S1 root territories.

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During skeletonization, the L5 lamina is flail. Inspection of the isthmi both sides revealed recent transverse fracture both of them. Revision of the MRI preformed 5 days ago did not show the presence of such fracture.

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Foraminotomy of right L5 root and the huge extruded disc was removed in several pieces lateral to the axilla.

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Meticulous cleaning of the disc space was performed from the right side and drilling of the disc space to achieve a 4 mm diameter window to the disc space. A big piece of bone harvested from the L4 spinous process was harvested and remolded to adapt it from intradiscal graft.

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Using the spreader the bone was pushed with impacter to the cavity to have later fusion of the area. After insertion of the graft the spreader released and check for stability of the graft, showed that back slippage is impossible.

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The epidural fat which was shifted upward due to severe compression, was transferred down to the level of relaxed roots.

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Smooth postoperative recovery and normalization of the power of both feet.

Comments:

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The patient is denying recent trauma to the spine but, she admitted that she went for traditional local treatment modalities, such are doing burn in certain  points. But the brother admitted that she felt down from 4 meters 1 month ago.

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This case is not unusual, since the local population believe in certain traditional therapies, such as burning and using woody instruments, which could cause such fracture. These low intelligent people usually try to hide this information and such findings are usually discovered during surgery.

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Due to poverty, the surgeon must act to resolve the fracture problem with minimal cost. The bone was harvested from the spinous process and impacted to the disc space with tension to aid future fusion.

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Preservation of the epidural fat and using it to cover the most mobile neural parts is the best solution to prevent scar formation and ease his pain in the long run.

 

 
     
 

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