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Dr. Ali Al-Bayyati and Dr. Munir Elias

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.fr

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19-JUNE-2012 HAKAM GHANEM AL-ATELY  52 YEARS  TUMOUR OF THE D9 WITH SEVERE COMPRESSION OF THE SPINAL CORD WITH OLD FRACTURE L1 WITH STENOSIS L1-2.

 

Anamnesis

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The patient came to Shmaisani hospital 14-June-2012 from Qatar with undiagnosed mid back pain for one month with exacerbation the last 10 days with agonizing pain when walking and numb both lower limbs. Chest CT-scan and US both kidneys were done 06-June-2012 and were reported normal. LSS X-ray done 08-June-2012 showing old wedge fracture L1. CT-scan done in improper way suggesting fracture of D9. The patient denying suffering major trauma and he mention that he suffered minor car accident one month ago. The patient had bullet injury 32 years ago and left thoracotomy was done at that time.

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On examination, the patient is bedridden refusing to walk. SLRS was 90 degrees both sides. There is weak dorsiflexion both feet 4/5. Before surgery there was weak all muscles both lower limbs -4/5.

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Bone scan done 16-June-2012 showing high uptake in the region of D9 and the 5th right rib. MRI dorsal spine with contrast and myelography showed a tumor of the D9 with severe compression of the spinal cord and destruction of the bony alignment and the mass filling the canal and reaching the anterior border of the D9 body. MRI lumbar spine also showing severe canal stenosis at L1-2 level. ESR was 5 mm/h and Bence-Jones protein in urine was negative.

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Using Inomed tumor dorsal spine protocol, skeletonization D7-8-9-19-11 was done lateral to the ribs. Laminectomy of D9 and lower half of D8 was done to expose all the borders of the tumor. The right Th9 root was severely involved with tumor which was pushing the spinal cord posterior. The soft part of the tumor was removed subtotally with preservation of the right root. FF biopsy gave the answer for plasmocytoma and did not ruled out lymphoma. The body of D9 was relatively preserved and in good shape after removing the tumor and it was decided to leave the body in place without violating it. Using Medtronic LEGACY FAS 6.5 x40 mm for Th 10 and Th8 and 6.5x45 for Th11 and 5.5x40 mm for Th7 transpedicular screws with bended rods 5.5 mm diameter  and CrossLink multispan 322 were used to  fused Th7-Th11. BCP bone graft 20 cc granules were used lateral to the rods and Th9 level. All stages of surgery were done using image-intensifier and ISIS Highline control.

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Routine closure of the wound. Smooth postoperative recovery with normalization of the power of the lower limbs.

 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient has tumor compressing the spinal cord threatening eminent plegia. Surgical interference must be performed regardless of the tumor nature.

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Coporectomy was not necessary in this case, because the shape of the body was acceptable.

Follow Up

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The patient came for follow up 05-February-2014 and check MRI showing resolution of the tumor. The patient was neurologically free.

 


Back Up!

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

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