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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.

 

 
 
 
 

08.  16-AUGUST-2007  SARA MUHAMED AHMAD  47 YEARS  HUGE EXTRUDED DISC D12-L1 LEFT SIDE.

 

 
 

Anamnesis

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The patient came to the clinic 08-July-2001 complaining of LBP for 17 years with left sciatica. MRI performed 23-June-2001 showed extruded disc D12-L1.

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On examination at that time SLRS was 60 degrees left side, hypalgesia all the left lower limb below the inguinal line with with weak dorsiflexion all toes left foot  and the left quadriceps. The patient was advised to undergo surgery and she disappeared.

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The patient came 05-August-2007 with the same clinical manifestations  with incontinence for 1 year  with SLRS 10 degrees in the left  and 40 degrees in the right. The weak dorsiflexion all toes increased and there is also weak planterflexion all toes left foot.

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The patient sent for another MRI and it was performed 09-August-2007 showing the same extrusion and small bulge disc L4-5

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Left D12-L1 hemiflavotomy was performed guided with fluoroscopy  and the the lateral edge of the isthmus was very medial, that only 5 mm was possible to preserve to reach the lateral edge of the dura. The extruded disc was removed in piecemeal fashion and the root was so adherent, that a small tear in the root lateral to the axilla was noted.

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After meticulous cleaning of the extruded disc and left sided cleaning of the space, the dural tear was repaired by nylon 6 zero.

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Smooth postoperative recovery and normalization of the power of the left lower limb.

Comments:

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The patient escaped for more than 7 years and the problem never resolved and her clinical picture became worse. This fact made the dura adherent to the extrusion and the tear was the natural subsequent problem, which could take place.

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The extruded disc material remained soft, which is unusual in this protracted period of time.

 
     
 

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