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TRUMPH TruSyatem 7500

 
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

 

The patient a doctor  came to the hospital 27-December from Iraq with longstanding history since 1985 of CCS with malacia of the spinal cord. As he claims, his condition was acceptable until he underwent labcholi 01-November-2005, after what he got severe quadriparesis with inability to walk. MRI and X-rays performed before and after the labcoli, showing that in addition to the CCS, he got pathological fracture of C5 with more damage to the spinal cord. On examination, the patient had parahypalgesia below C4 and quadriparesis at the same level with the power more affected in the left side. There were no micturition or defecation problems.

Considering that his fracture is a pathologic one, it was decided to perform corporectomy of C5 with removal of the disci C4-5 and C5-6 and the material was sent to histological studies. So as not to have problems with possible osteomyelitis of the lesion, a  24 mm fibular graft was harvested from his right leg and using Syntex cervical miniplate, the graft was fixed to the device and both were applied to fill the gap and to fuse C4 and C6 accordingly and gain acceptable bony alignment.

The power of the right upper limb and the distal muscles of both lower limbs improved immediately after surgery. The other muscles in the next operative day remained the same and the patient feeling that, the proximal muscles of the left leg became more weak.

The patient came 5 days after surgery with some further improvement of the upper limbs with the histologic result taken during the surgery confirming the presence of osteomyelitis without presence of malignancy, which explain the cause of his pathologic fracture during anaesthesia for the performed labcholi.

Comment:

This is an example, that deformity of the spine with subsequent disc extrusion and the pathologic fracture in this case could be osteomyelitis of the bony structures or the endplates. This must be considered in some cases, when, especially the patient progress fulminating picture of discitis or osteomyelitis after surgery. The surgery in these circumstances provoke the infectious nidus and over several weeks the patient start to progress escalation of pain and etc. problems.

 

 


  

[2005] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved