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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.  25JANUARY-2007  IBRAHEEM AHMAD DAWOOD  44 YEARS  EXTRUDED DISC L5-S1 LEFT DOWNWARD MIGRATION.

 

 

Anamnesis

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The patient came to the clinic 22-December-2007 complaining of LBP for 2 years. Exacerbation of left sciatica the last 11 days down to left L5 root territory and positive cough sign.

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MRI of bad quality performed 11-July-2004 showed extruded disc L4-5 with left upward migration.

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The patient is limping with exaggerated scoliotic stance  with SLRS 45 degrees in the right and 30 degrees in the left with hypalgesia left L4 and L5 territories and almost drop left foot.

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The patient was sent for new MRI, which showed left L5-S1 disc extrusion with downward migration.

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Left S1 foraminotomy was performed and left L5-S1 hemiflavotomy was achieved. The extrusion was removed from under the axilla. Minimal cleaning of the disc pace was performed from the left side.

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Smooth postoperative recovery.

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, but here the disc material was looking healthy, for what minimal cleaning was limited.

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The epidural fat was acceptable and was kept and preserved until the end of the operation.

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The disc space of this patient is not narrow and the cleaning was performed minimally and the defect in the annulus fibrosis was minimal, which could predict an estimated incidence of 7% recurrence rate.

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All the time, do not hesitate to ask for new MRI, if the previously performed MRI is of bad quality  or an old one. The morphologic data could be different and mistakes could be avoided by following such policy.

 

 
     
 

Copyright [2007] [CNS Clinic]. All rights reserved