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The
patient is a Libyan citizen came to the clinic
08-February-2012 complaining of difficult
walking after surgical intervention performed in
Libya 15-January-2009. Fixation of L4-5 and S1
was performed at that time. The patient
continued to deteriorate and MRI cervical spine
performed 06-October-2011 showing small disc
C6-7 , but dorsal MRI showing severe stenosis of
the canal at D4-5, D5-6, D10-11 and D11-12. |
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On
examination, the patient cannot walk with severe
atrophy of both lower limbs. There is profound
weak both lower limbs 3/5 of all muscles.
Babinski sign was positive both sides, but there
was no clonus. No sensory deficit. |
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The
patient was sent for further evaluation. MRI of
the brain performed 20-February-2012 showing
scattered lacunar infarctions both cerebral
hemispheres. MRI dorsal spine performed
13-February-2012 showing severe stenosis at the
above mentioned levels with malacia of the
spinal cord at these levels. The stenotic
elements were due to ligamentum flavum
hypertrophy. |
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The patient was operated as
first stage 4
days ago. She was given 2 units blood and Hb
after surgery was 8.0 and became 13.8 after
transfusion. |
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Laminectomy of D9-10-11 was
performed with drilling of the most adjacent
bone structures to the dura. The compressed bony
parts were not only adherent to the dura, but
the dura was missing at several areas. All
the bony and soft tissues elements were removed.
Some areas of calcified dura was left in place.
There a lot of dural defects in the exposed
field and it is impossible to repair them.
DuraGen Plus Integra 2.5 cm x 7.5 cm was
applied to the area. Another layer was applied
over the first one. Water-tight closure of the
wound. |
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Routine
closure of the wound. Smooth postoperative
recovery with improvement of the power of both
legs. |
