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06-JANUARY-2017 ALI MAHER MUBARAK 64 YEARS
OSTEOMYELITIS D8-9-10 WITH PENDING COMPLETE PARAPLEGIA.
The patient was operated by me 1997 for PLD
L5-S1 and was doing well. The patient then
progressed heart failure 2002 and was treated
conservatively. I march-2015 heart pacemaker was
inserted in India, after what the patient
progressed heamaturia was was treated for long
time for UTI. The patient then progressed back
pain and CT-scan performed 20-November-2016 mild
bulge L3-4. The patient then came
09-December-2016 to the clinic walking with
complains of back pain.
On examination, the patient was neurologically
free except for midback pain. Considering that
it was dangerous to perform MRI of the whole
spine, it was decided to perform whole body
CT-PET with other investigations. PET-CT-scan
was performed 11-December-2016 and showed
hyperactive lesion extending from D8, 9 to D10.
The patient was sent to oncologic consultation
and investigations confirmed the presence of
Klebsiella pneumonia sensitive to Gentamicin and
Amikacin. He was treated by infectious
specialist by Tygacil 50 mg I/V
The patient then came 05-January-2017 telling
that he showed dramatic deterioration , in
wheelchair with plegia right lower limb and
severe weakness left lower limb with analgesia 5
cm above the umbilicus and below both sides.
The patient was sent for new investigations and
Chest CT-scan was without proper information,
but continuous thin cuts 0.75 mm from D4 down to
the mid of D11 with contrast, using ORSVisual
application, it was possible to see the supposed
to be an epidural
pus fulfilling the right side from D8-9-10 with
paravertebral abscess reaching the aorta and
retropleural cavity both lungs.
Skeletonization of the right
side of D8-9-10. Right hemiflavotomy D9-10 and
D8-8. No pus is coming out, but severe
compression was noted. Complete decompressive
laminectomy D9, upper half of D10 and lower half
of D8 until the normal epidural fat was noted.
There is remnants of epidural fat with
inflammatory process. The decompression was
performed, so that to preserve stability of the
dorsal spine and provide sufficient
decompression to the spinal cord. Routine closure of the
wound with Ready Vac .
Smooth postoperative recovery. The power of
the left leg improved dramatically, but the
right lower limb still the same.
He was sent to the ward.
The patient having viscous cycle of
infection hitting several organs started after heart
CT-scan in not reliable technique for
soft tissue detection in the spinal column. It can give
disinformation up to 70% as in this case.
Surgical decompression was necessary in
this case and the uncertainty of the CT-scan date were
considered to put plan A and B.
Adamkiewicz arteries supply the spinal
cord from the left side. Here the clinical picture is
opposite. Despite that Nootropil and Clexane were started
after surgery to rule out vascular compromise.