www.neurosurgery.tv 
   

neurophysiology.ws
neurosurgery.tv
e-neuroradiology.com
onconeurosurgery.com
craniopharyngiomas.com
pituitaryadenoma.net
meningiomas.org
neuro.science

Surgical group is like a football team.

 
Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
cns-online.com
cns.surgery
cns.today
e-neurosurgery.com
neurosurgery.ag
neurosurgery.bz
neurosurgery.co
neurosurgery.cz
neurosurgery.gallery
neurosurgeryvideo.gallery
neurosurgicalvideo.gallery
neurosurgery.guru
neurosurgery.me
neurosurgery.mx
neurosurgery.photos
neurosurgery.tips
neurosurgery.tw
neurosurgeryspine.org
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.com
neurosurgicalencyclopedia.net
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
craniopharyngiomas.net
ependymomas.com
ependymomas.net
glioma.co
gliomas.info
meningiomas.info
meningiomas.org
neurooncology.me
neurooncology.tv
neurooncology.ws
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com
pituitaryadenoma.net
schwannomas.com

Neuroanatomical Sites
diencephalon.org
humanneuroanatomy.com
medullaoblongata.info
mesencephalon.org
microneuroanatomy.com

Neuroanesthesia Sites
neuroanesthesia.info

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com
neurophysiology.ws

Neuroradiological Sites
neuroradiology.ws

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com
vascularneurosurgery.net

Personal Sites
cns.clinic
cnsclinic.org
munirelias.com

Spine Surgery Sites
spine.surgery
spinesurgeries.org
spondylolisthesis.info
paraplegia.ws

Stem Cell Therapy Site
neurostemcell.com


Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

26-OCTOBER-2010  RAMEZ DARWEESH MALHIS  85 YEARS  FRACTURE DISLOCATION C3-4 WITH OBLIQUE FRACTURE GAP AND ANKYLOSING SPONDYLITIS.

Anamnesis

bullet

The patient was admitted to Arabic Center 26-October-2010 after falling down in the early morning. He progressed small ICH hematomas both cerebral hemispheres and severe fracture of the C3 and C4 bodies with dislocation of the upper part of the cervical column from the the caudal part with severe extension disruption. He got also several minor injuries. He is a known patient with Ankylosing spondylitis and Alzheimer  disease.

bullet

MRI and CT-scan performed confirming the presence of the above mentioned fractures of the cervical spine.

bullet

The patient was sent to Shmaisani hospital and upon examination with the Philadelphia collar, he was moving all limbs and he was not responding to verbal commands due to advanced Alzheimer disease.

bullet

Using anterior approach with weight 15 Kg applied to the Hallo traction was unable to perform any reduction of the dislocation. Skeletonization of C2, C3-4-5 revealed that the C3 and 4 were completely crushed. Traction was increase to 18 Kg and various positions with neural and overflexion was used to perform open reduction. It was possible to perform the reduction after removing several bony obstacles, locking the dislocation with the patient in overflexion setting.

bullet

Using 3 level Trinica plate, the screws were inserted to the C2 body and part of the deformed C3 in the left side. It was impossible to use the C4 because it was friable, for fixation. Three screws were used to fuse C5  at different locations. Overdistraction with weights over 18 KG were avoided  so as to avoid traction injury to the spinal cord. Trying to put the patient in stress extension, showed that the lower screws slipped out from their places and the dislocation regained the initial position. The patient was put back in flexion traction and longer 18 mm screws with wider diameter 4.6  were reinserted to different directions. The traction was removed and another check for the screws was performed. The construct is stable . 12 ml Novabone was inserted to fill the bony gaps were there was no bone at C3 and C4 bodies. The reduction was not perfectly reduced and it was acceptable.

bullet

Routine closure of the wound and the patient was awakened and he start to move the four limbs. He was put in ventilator to 2 days to pass the period of retropharyngeal swelling.


Comments

bullet

The patient has an ugly dislocation with complete destruction of C3 and C4. This type of fracture is unstable and can trigger a fatal sequels if not fused and stabilized.

bullet

The ankylosing spondylitis  made the fracture strangely looking, that the fracture was involved the bones and calcified tissues. The later caused difficulty in performing even open reduction.

bullet

Over distraction was avoided to prevent vertebral arteries injury or spinal cord distraction, for what the acceptable reduction was sufficient to achieve.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Check X-ray done 28-October-2010 showing the degree of reduction and fixation. Notice the Novabone mixed with contrast agent.


Back Up!

Notice: Not all operative activities can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also escaped from the plan .

 

  WELCOME TO AL-SHMAISANI HOSPITAL

  

[2010] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved