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20-APRIL-2011 ABDALLA ABDEL-KAREEM AL-GHMEZ
57 YEARS RESIDUAL AFTER FIXATION OF THE C7-D1 WITH PROGRESSIVE
STENOSIS AT SAME LEVEL.
Anamnesis
The
patient was operated by me
21-July-2010 for
fracture dislocation C7-D1 with quadriparesis,
after what he dramatically improved.
The
patient then 20 days after the surgery started
to complain the return of hypalgesia of the
right side of the body below the umbilicus.
The
patient then came to the clinic 13-November-2010
complaining of further deterioration of the
sensation reaching the right C6 level with
slight hypalgesia 10 cm below the left nipple.
The power of the four limbs was full. He was
advised to continue medical treatment.
On
examination: the patient has good power of the
four limbs, but he us using crutches due to
impaired sensation with complete aneasthesia of
the right lower limb up to the knee.
The
patient was sent for MRI cervical spine and done
18-April-2011 showing mild stenosis at C7-D1.
The major compression is due to the posterior
elements, where the CSF is lacking at the lamina
of C7. Dynamic studies of the cervical spine
confirmed stability of the construct of Trinica
cervical plates and screws at C7 and D1.
Decompressive laminectomy of C7 and partial of
C6 and D1 was performed. The compressed parts
were lacking the epidural fat. The ligamentum
flavum was adherent to the dura at the most
compressed area, which was removed by sharp
dissection to prevent dural tear.
Routine
closure of the wound. Smooth postoperative
recovery with decrease of the numbness of the
four limbs..
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Comments
This case and the case performed
26-March-2011 are
similar in their scenarios, that after dramatic
improvement, they showed deterioration of the
posterior elements of the spinal cord.
In this case the Fidji cage was used and sinking
of the cage was mostly the cause of sensory
deterioration.
In the future, it is preferable to use a cage
with wider and higher dimensions to to escape
this sinking event, which necessitate for second
surgery.
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 .
