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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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4.   12-MARCH-2007  TAMAM MUHAMED BDIER  55 YEARS  LCS L3-4 WITH LEFT LATERAL SYNDROME WITH SLIPPED FRAGMENT FROM THE LEFT L3-4 FACET JOINT.

 
 

 
 

Anamnesis

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The patient came to the clinic 07-March-2007 complaining of LBP for 15 years  without sciatica. The last 2 weeks got exacerbation of LBP with left sciatica.

MRI lumbar spine performed 05-March-2007 showing huge extrusion of L3-4 with up and downward extension left side.

On examination: the patient  is limping  with scoliotic stance  with urgency and frequency of urination. SLRS was  50 degrees in the right and 20 degrees with shooting pain in the left. Complete drop left foot with weak dorsiflexion right foot 4/5 and left foot 3/5. Sensory los of the midthird and below the right forelimb and above knee of the left lower limb. The patient is a known diabetic  for 5 years with hypertension  for 10 years.

Partial decompressive laminectomy of L3 and 4 with foraminotomy for L4 and L5 roots both sides was achieved and all the compressive elements were eliminated.

The extruded fragment was from the left facet joint and was severely compressing the left L4 root at the root canal level.

Inspection of the L3-4 disc space was negative for presence of any extrusion from the disc, for what it was decided not to violate it.

Routine closure of the wound and smooth postoperative recovery with improvement of the motor power both feet.

Comments:

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It happens that, misreading of the MRI can lead to disturbances in planning of surgery. Surgery was needed in all situations, but the surgeon must consider any variations or possibilities and to be open-minded for all possibilities.

The compressive elements where coming from the left facet joint and the presence of good epidural veins over the disc space ruled out the disc as the origin of her problem. LCS played a major role in escalation of her deterioration, that such prolapsed facet joint mimic the clinical picture of extruded disc.

The patient showed dramatic improvement of her weakness, but the drop foot regained some improvemt.

 
     
 

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