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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.  26-APRIL-2007  HANAA KHADER ABBAS  46 YEARS  POSTDISCECTOMY III DEGREE SPONDYLOLISTHESIS L4-5 WITH AGONIZING SCIATICA AND WEAK BOTH FEET.

 
 

 
 

Anamnesis

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The patient came to the clinic 23-April  with agonizing bilateral sciatica and severe weak both feet with inability to walk more than 100 meters.

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The patient was operated 22-May-2006 for PLD L4-5 with subsequent deterioration of her condition.

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MRI done 26-January-2007 with LSS X-ray confirmed the presence of III degree spondylolisthesis L4-5 with complete absence of the isthmi.

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On examination: the patient had exaggerated scoliotic stance  with SLRS 40 degrees both sides with more pain in the right. The right foot dorsi and planterflexion were 3/5 and the left 4/5. There was hypalgesia of the right L5 and S1 territories.

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Skeletonization of the lateral masses of L5-S1 both sides and the L4-5 respectively. There were no lateral masses. The transverse processii were identified and using transpedicular screws 45 mm length and 7.5 mm width with 2 polyaxial type in the upper side and rigid in the lower part, transpedicular screw fixation was performed with distraction-reduction with bridge inserted between the 2 rods.

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Smooth postoperative recovery with normalization of the power of both feet.

Comments:

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The patient underwent surgery for discectomy  1 year ago elsewhere. The isthmi were destroyed with subsequent progression of III degree spondylolisthesis. It is hard to tell if that was the result of surgery, or a hidden finding, which was escaped during surgery. It happens, as in this example, that the patient got fracture of the isthmi before surgery, but removing the isthmi during the first surgery still possible.

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In either cases, considering, that the patient had deterioration, without improvement during the 12 months period, surgery with fusion is the only solution to this situation.

Postoperative Lateral LSS X-ray Postoperative LSS X-ray AP-view

 

 
     
 

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