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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.

 

 
 
 
 

2.  13-FEBRUARY-2007  MUHAMED ALLA-EDEEN AL-HASAN  17 YEARS  SLIPPED EPIPHYSIS L4-5 WITH MORE EXTRUSION TO THE RIGHT.

 
 

 
 

Anamnesis

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The patient came to the clinic 11-February-2007 complaining of right sciatica for 5 months  with numbness of the right S1 root territory.

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MRI lumbar spine done 08-February-2007 showed prolapsed lumbar disc L4-5 with left midio-lateral extension as manifestations of slipped epiphysis.

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On examination: the patient had exaggerated scoliotic stance and limping during walk. SLRS was 15 degrees in the left with pain and 45 degrees in the left with shooting pain to the right leg. Weak dorsiflexion all toes left foot 3/5 and planterflexion  4/5.

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Bilateral foraminotomy of both L5 roots was performed and the right root was pushed and compressed lateral and the slipped epiphysis was attacked from under the axilla. The extruded slipped epiphysis was removed  from both sides trying to leave the posterior longitudinal ligament intact.

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The foramina were checked for patency. Meticulous cleaning of the disc space was achieved from both sides, because the defect of the destroyed annulus fibrosis was very wide.

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Epidural fat transfer to the roots and routine closure. Smooth postoperative recovery.

Comments:

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In patients under the age of 18 years the pathologic process of disc extrusion take a different etiological character. It is usually the result of slipped epiphysis. The slipping was so severe that, the right L5 root was entirely compressed and the slipping was huge, for what surgery was necessary.

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The most youngest in this series of patients was 12 years age year age boy.

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It is more appropriately to name this kind of operation, not discectomy, but epiphysectomy and usually it needs bilateral intervention to entirely remove the whole slipped epiphysis.


 

 
     
 

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