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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

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Multigen RF lesion generator .

 

27-OCTOBER-2008  MUHAMED AL-SAYED ABU-HAMADEH  75 YEARS PARAPLEGIA BELOW C5 AFTER RTA 25-OCTOBER-2008 WITH UNSTABLE FRACTURE  C6 AND EXTRUDED DISC C5-6.

Anamnesis:

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The patient was admitted to Al-Shmaisani hospital with clinical picture of paraplegia below C5 after suffering RTA 25-October-2008. The patient was sent to the ICU to observe the vital functions. His breathing pattern was affected, but tolerable, due to absence of chest wall movements. He was hypertensive  and he showed rhythmic bradycardia. The patient has hallucinations 15 years ago. He has fracture left clavicle.

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On examination: total paraplegia of all muscles and sensation below C5.

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MRI cervical spine was performed and showed contusion of the spinal cord starting from C3 down to D3. The body of C6 was wedging and the anterior osteophytes and the posterior calcified longitudinal ligaments were fractured with huge disc extrusion of the C5-6 compressing the spinal cord.

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Osteophytectomy was performed over C5-6-7. The extruded disc C5-6 was removed. There was no tear in the dura, but it was contused. All the steps of the operation were performed with traction 5 KG with slight extension. Before applying fixation, it was necessary to put the neck in flexion position to bring the anatomical structures in acceptable position, after what using Hybrid cervical miniplate with 6 screws were used to fix C5-6-7.

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All the steps of the operation were guided with image-intensifier. Smooth recovery with the same neurological status.

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The patient started to show deterioration of his breathing pattern , for what he was put in ventilator the morning of 30-October-2008. The patient was taken to the operating room and tracheostomy and continuous drainage of the lumbar CSF was achieved by inserting tube subdurally in the lumbar spine, using Touhy needle gauge 14.

Comments

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The patient has severe contusion of the spinal cord. The aim of surgery to put the patient in chair as soon as possible.

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The degree of improvement in the future will depend upon the recovery of the spinal cord.

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The patient has obesity and diabetes mellitus and hypertension. These factors playing a major role in the prognosis. Since the chest wall muscles were paralyzed and the huge abdomen played a critical role in deteriorating his breath pattern.

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Notice: Head injuries and very urgent surgeries are also escaped from the plan .

     

  

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