Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
neurosurgery.art
neurosurgery.me
neurosurgery.mx
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
ependymomas.com
gliomas.info
gliomas.uk
meningiomas.org
neurooncology.me
pinealomas.com
pituitaryadenomas.com 

Neuroanatomical Sites
humanneuroanatomy.com 
microneuroanatomy.com

Neuroanesthesia Sites
neuro-anesthessia.org

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com

Neuroradiological Sites
neuroradiology.today

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com

Personal Sites
cns.clinic

Spine Surgery Sites
spine.surgery
spondylolisthesis.info
paraplegia.today

Stem Cell Therapy Site
neurostemcell.com


 

Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


 

Multigen RF lesion generator .

23-OCTOBER-2022  HAMZEH ALI EL-SHAYKH  42 YEARS  HUGE EXTRUDED DISC L4-5 WITH RIGHT UPWARD MIGRATION.

 

Anamnesis

bullet

The patient came to the clinic 26-May-2018 complaining of LBP with right sciatica after lifting heavy object yesterday. MRI lumbar spine done the same day showing bulge L4-5, more to the right and bulge L5-S1. SLRS was 70 degrees right side with no neurological deficit. He was treated conservatively and improved. The patient then came 11-October-2022 with history of LBP for 6 months with right sciatica with exacerbation last 4 days. He is in agonizing pain. He has irritable colon, for what colonoscopy done 4 years ago with ulceration?

bullet

On examination, the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 20 degrees right side with pain and 80 degrees left side without pain. There is weak dorsiflexion right foot -4/5. 

bullet

The patient was sent for investigations and MRI done the same day showing the huge extruded disc L4-5 with right upward migration.

bullet

Right L5 foraminotomy with right sided removal of the extrusion and right sided cleaning L4-5 disc space. Using MultiGen, bipolar stimulation of the right L5 root was responding to 2.3 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right L5 root  was achieved using 2 bended catheters 10 mm exposed length. Further bipolar stimulation of the right L5 root was responding to 2.0 Volts. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. The power of the right foot improved. He was sent to the ward.


MultiGen

FOLLOW UP

bullet

Too early now.

Comments  

bullet

The recurrence rate here is around 7%, because the disc space is not shallow.

bullet

This is the 244th case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference.

bullet

It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tells that the electrodes did not migrate during the procedure and the nerve is functioning properly. The nerve improved moderately in motor stimulation after performed BPRF.

bullet

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

bullet

It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status was the same and the anesthesia protocol also the same.

bullet

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 5 minute session in most cases.

bullet

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below or above the level of the axilla.

Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.


Inomed Riechert-Mundinger System, with three point fixation is the most accurate system in the market. The microdrive and its sensor gives feed back about the localization.


Inomed MER system

Leica HM500

Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014

LooksCam II in the run.
LooksCam II Xenosys in the run  starting from  14-March-2021 with SheerVision TTL x4 magnification. 

 
Cios-Spin flat panel in the run.

 

 


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 .


WELCOME TO AL-SHMAISANI HOSPITAL

 

© [2022] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved