The patient came to the Emergency of Shmaisani hospital 25-January-2004 after suffering severe injury to his spine due to elevator falling upon him 3 months ago with los of consciousness. He was transferred first to Al-Bashir hospital were he was treated for fractures of the feet and twice operated for his spine with complications and infection.

On examination: The patient is complete paraplegic and para-anesthesia below D11. There is no sensation for defecation and in Foley's catheter.

The patient went thorough investigations and MRI done showing complete cut of the spinal cord at Th12 with flail spine and fracture and far dislocation of L1.

Skeletonization of D 9 down to L3. The bony elements resisting reduction were nibbled or drilled off to facilitate reduction. The torn dura was opened and inspection of the edematous spinal cord was seen and the cut above. It was decided to harvest sural grafts. The functioning Th10 and Th11 were identified both sides at the level of the transverse proccessi and at post-ganglionic level was cut for 90% for 2 reasons. First to prevent the root slipping up and to leave some innervation to the original root. From the cauda equina 2 roots of L2 and L3 were isolated from both sides and cut. Anastamoses with sural grafts was achieved between Th10 and Th11 and these motor roots. The dura was closed water-tightly and at the same time to prevent severe compression to the grafts and to prevent postoperative CSF leak. Using Luque rectangle adapted to align the normal curve of the area, fixation of D10 down to L3 with sublaminar wires was applied. Routine closure of the wound. Smooth postoperative recovery. The neurologic status is the same. He was sent to the ward.

The patient was sent back to Al-Bashir hospital due to financial reasons and escaped from follow up. I was disappointed that I could not follow up the patient to see the result of the anastamoses.

This kind of anastamoses is the first to my knowledge and It is intended to make the patient have some motor function below the the level of the injury. At least to make him able to walk with aid.