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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.

 

 
 
 
 

4.  24-JANUARY-2007  MUHAMED SALEEM SALEH  54 YEARS  EXTRUDED DISC L4-5 WITH RIGHT DOWNWARD MIGRATION - DIABETES MELLITUS.

 

 

Anamnesis

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The patient came to the clinic 07-December-2004 complaining of LBP for 4 years with right sciatica. The patient is a known diabetic for 9 years. The patient is left handed with Hoffmann positive in the right with weak grip and extension of the right hand and right triceps muscle. The patient was limping and with SLRS 45 degrees in the right with weak right foot. MRI of the brain, cervical and lumbar spine were requested, but the patient escaped.

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The patient then came to the emergency of Al-Shmaisani hospital 19-January-2007 with agonizing right sciatica. He had exacerbation of right sciatica the last 3 months. He was unable to sleep the last week. MRI of the lumbar spine was requested and done 21-January-2007, showing a huge extrusion of L4-5 disc with right downward migration.

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On examination, the patient was unable to walk and drop right foot with hypalgesia of the right L5,S1 roots.

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Right L5 foraminotomy with right L4-5 hemiflavotomy was performed and the downward migrating disc was removed from under the axilla in several pieces. The root became free, but it is swollen.

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The root was shifted medially and the the disc space was cleaned from the sequestrated intradiscal material. Moderate amount was removed.

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The epidural fat was shifted to cover the root, to minimize the scar formation.

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Smooth postoperative recovery and the power of the right foot became normal.

Comments:

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Minimal cleaning of the intradiscal space proved to heighten the incidence of recurrence, so that, it is preferable to perform intradiscal cleaning of the sequestered material inside the disc space, after removing the extrusion.

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Epidural fat local transfer is the best solution to prevent scar formation at the root trajectory. This maneuver decrease the postoperative pain suffering.

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The disc space of this patient is not narrow and the cleaning was performed moderately and the defect in the annulus fibrosis was minimal, which could predict a lower than 7% recurrence rate.

 

 
     
 

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