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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.

 

 
 
 
 

13.  17-NOVEMBER-2007  NIHAYA RUSHDY SALEEM  67 YEARS  SPONDYLOLISTHESIS C3-4 AND C5-6 WITH PCD C3-4 AND MALACIA OF THE SPINAL CORD AT C3-4.

 

 
 

Anamnesis

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The patient came to the clinic 14-November-2007  complaining of LBP for 4 years  and four limb pain for 6 months with neck pain with weak both upper limbs for 2 months  and difficulty in walking for the same period.

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MRI of the brain showed chronic sinusitis with scattered small lacunar infarcts both cerebral hemispheres and partially empty sella. MRI cervical spine performed 13-November-2007 showed spondylolisthesis C3-4 and C5-6 with fusion of C4-5 and malacia of the spinal cord at C3-4 level. There is an old osteophytic mild extrusion of C6-7 left side of no clinical importance.

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On examination: The patient has weak both deltoids 4/5 and left biceps brachii 4/5 and both hands grip 3/5  and extension 3/5 right hand and 4/5 left hand with weak triceps right 3/5 and left 4/5. There is hypalgesia right C$ and 5 territories. Hoffmann sign positive both sides and Lhremitte sign positive when flexing the neck. Deep tendon reflexes all were exaggerated in both upper limbs and lower limbs with Babinski positive both sides with weak planterflexion both feet and hypalgesia of the left leg below the knee.

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Discectomy of C3-4 was performed and drilling of the anterior osteophytes of C4-5 was performed and using the Hybrid Reflex miniplate and screws were applied to fuse the C3 down to C6 bodies with traction of 12 Kg applied and reduction of the spondylolitic elements achieved by the three level construct.

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Image-intensifier was used in all steps and Inomed Highline ISIS left carotid scenario was used for iom.

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Routine closure of the wound and smooth postoperative recovery with improvement of the power of the four limbs.

Comments:

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Cervical canal stenosis is a progressive disease and if it is showing deteriorating course surgery is mandatory to prevent further damage to the neural tissues.

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In this case the mobile segments of C3-4 and C5-6 with the C3-4 extrusion were playing more major deleterious effect in the spinal cord and decompression with fixation of the mobile segments was more important than the stenosis.

 
     
 

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