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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.  16-MAY-2007  MAHA ATTA MUSTAFA RAMADAN  42 YEARS  PARAPLEGIA BELOW L1 DUE TO EXTRUDED DISC L1-2 WITH SEVERE SEGMENTAL STENOSIS AT THIS LEVEL. IATROGENIC INSTABILITY OF L4-5 AFTER 2 SURGERIES FOR LOWER LUMBAR SPINE.

 
 

 
 

Anamnesis

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The patient came to the clinic 12-May-2007 in wheelchair complaining of complete paraplegia below L1 level with loss of micturition and defecation control.

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The patient underwent surgery for PLD L4-5 1996 for left sciatica. The patient then was operated 20-February-2007 for the "recurrence".

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On examination: the patient had profound weak both quadriceps muscles 1/5, abduction and adduction of the knees 0/5 and the dorsi and planterflexion both feet is 0/5. She has no sensation for micturition and defecation.

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MRI lumbar spine performed 25-April-2007 showing severe stenosis L1-2 with extruded disc obliterating the space more from the left, with spondylolisthesis L4-5 due to absence of the isthmi of L4-5 both sides.

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Decompressive laminectomy of L1 and L2 was performed, using drilling to prevent surgical trauma to the spinal cord. The isthmi are very close to the midline. Considering that, foraminotomy of left L2 root was performed without violating the stability of the region. The extruded disc was removed from the left side lateral to the axilla. Meticulous cleaning of the disc space of L1-2 disc space from the left.

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Under the image intensifier the remnants of the L4 and L5 were identified and transpedicular screw fixation with reduction and distraction was performed between L4 and L5 bodies. Bone graft was inserted between the lateral processii of L4 and L5. Routine closure of the wound.

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Smooth postoperative recovery.

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The patient showed mild improvement of the quadriceps and abduction and adduction of the knees immediately after the operation and start to feel pain in the right lower limb.

Comments:

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Removal of the isthmi could cause segmental instability, as in this case. The patient was not complaining about this instability, because, she was paraplegic below L1 level. This problem will show up in case of improvement of the neurological status after surgery. So as to avoid this future situation, transpedicular screw fixation and reduction was performed.

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Careful neurologic evaluation, must be performed to avoid mistakes in decision making and planning for surgery. The patients main problem was at the level of L1-2. Despite this fact, the patient was sent to perform MRI of the dorsal spine, so as not perform another mistake.

 
     
 

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