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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.

 

 
 
 
 

7.  28-MARCH-2007  SAMI ABDEL-LATEEF YOUSEF  71 YEARS  EXTRUDED DISC L4-5 WITH LEFT UPWARD MIGRATION.  

 
 

 
 

Anamnesis

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The patient came to the clinic 26-March-2007 complaining of difficult gait for 3 years with numbness four limbs. Exacerbation of LBP with left sciatica the last month.

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MRI of bad quality done 13-March-2007 done showing extruded disc L4-5 with upward migration. MRI of the cervical spine performed later showing spondylolisthesis C5-6 with stenosis and malacia of the spinal cord at that level.

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On examination: the patient walking with aid and crutches. The patient is left handed using the right. The power of the right upper limb is diminished 4/5 with weak dorsi and planterflexion left foot  and severe weak left quadriceps muscle 3/5. SLRS was 50 degrees in the right and 5 degrees in the left with agonizing pain. Babinski was positive in both sides.

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The patient was sent for new MRI of the lumbar spine, which was performed and more clearly demonstrated the extrusion and the left side upward migration of the piece.

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Considering that the extrusion is causing an agonizing pain it was  decide to operate first the lumbar spine and later to manage the cervical problem.

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During positioning of the patient in the operating table, great care was directed to the cervical spine to avoid possible complications of the cervical spine.

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Left L4 hemilaminectomy was done and the extrusion was removed and the disc space of L4-5 was cleaned from the left side.

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Routine closure of the wound and smooth postoperative recovery with improvement of the motor power left foot.

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Another time great care was paid for the cervical spine during transfer from the operating table to the ward.

Comments:

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Considering that the extruded disc was an agonizing one, exception was made to operate the patient in the lumbar spine. Usually precedence is directed to the cervical spine, but in this case it was an exception.

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The patient must be operated later for his cervical problem and an interval of 3-4 months must be waited until the patient recover from his first problem.

 

 
     
 

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