|
 |
|
 |
|
|
|
|
|
 |
 |
|
 |
NEWS
January/06/2007
Surgical treatment in
paraplegia survey:
Cross-anastamosis in paraplegia below D9 started to give
results. The last documented case operated 1 year ago in a patient from Israel came
to the clinic 3 weeks ago. ECS and EMG performed showed that there is
starting innervation of Th 11 and 12. The patient's lower limbs muscles
became bulky and he could contract the lower abdominal muscles and some
movements in the pelvic girdle. Crude sensation descended down to the
inguinal level both sides. If you are more interested in this topic,
click here!
March/08/2007
Tuberculosis of the
spine
In the last 2 years the incidence of
tuberculosis of the spinal column is becoming more frequent and having
different clinico-morphologic picture. This phenomenon is alarming sign
as the residual of the use of dirty bombs and several radioactive
materials in the surrounding dirty wars in the region. For demonstration
click here! and
here!
20-AUGUST-2007
SIEMENS Digital C-arm is implemented and
functioning in the Shmaisani hospital.
30-AUGUST-2007
The Inomed ISIS Highline neurophysiologic
navigation system start to work at the operating room.
28-November-2013
Magnetom Skyra 3 tesla with all clinical
applications start to run.

|
|
|
 |
 |
|
|
|
 |
 |
|
 |
6. 22-FEBRUARY-2007
IETEDAL SAEED AHMAD 50 YEARS DISCITIS L4-5
WITH LEFT UPWARD ABSCESS. ACTIVE TUBERCULOSIS OF THE
SPINE.

Anamnesis
 |
The patient came to the
clinic 18-February-2007 complaining of LBP for
2 months with right sciatica which shifted to
the left after 2 weeks. |
 |
MRI lumbar spine done
16-February-2007 showed a small
extrusion of L5-S1 disc. |
 |
On examination: the patient
was in agonizing pain with scoliotic stance with SLRS
10 degrees both
sides. There was weak planterflexion left foot 4/5
and hypalgesia below right L4 root territory. |
 |
Considering that, the MRI is
not convincing for her clinical data, repeat MRI
was requested with LSS-X-ray. It was done and
showed a huge migrating mass from L4-5 in the
left side upward migrating and far-lateral with
involvement of the psoas muscle. Tumorous
process or infection were suspected and
migrating disc fragment was also considered. |
 |
Left sided hemilaminectomy of
L4 was performed. The epidural fat is adherent
to the dura with thicker consistency, than
usual. The left L5 root was identified and
followed upward. There is a pocket of puss,
which was aspirated by syringe and sent for
investigations. Cleaning of the puss pocket from
the lateral aspect and the tiny defect in the
upper margin of the L4-5 annulus fibrosis was
found and a pussy material came from the disc
space. The cavities were cleaned meticulously
and the wound irrigated with gentamicine. The
annulus fibrosis was acceptable and the root
became relax, for what attempts to violate the
disc space was intentionally abandoned to
prevent further spread of the infection to the
bony structures. |
 |
Routine closure and smooth postoperative recovery and
improvement of the power of left foot. |
 |
T.B. IgG performed and result
released 04-March-2007 and was positive (865.2
U/ml), which confirmed tbc of the pathological
process and the patient was kept in anti-tb
treatment for the next three years.
|

Comments:
 |
The clinical picture was not
in compliance with the first performed MRI.
Repeat MRI confirmed the presence of another
process, which required surgery for
verification. |
 |
The epidural abscess was
evacuated and irrigated meticulously and the
disc space was also full of pus, confirming,
that discitis was the source of infection. |
 |
No attempt was made to
violate the intradiscal material, so as to avoid
spread of the infection with subsequent
osteomyelitis. The annulus fibrosis was
acceptable and the left L5 root was relax. |
 |
When you are doubt about the
radio-morphologic and clinical data
recheck and recheck so as to avoid catastrophic
consequences. |
 |
Tuberculosis of the spinal
column is becoming more frequent incidence in
Jordan in the last 2 years. It has different
morphologic and clinical picture. The cause
could be the politically unstable zone with the
use of dirty bombs and the raised radiation in
the area, which needs special study from
authorized organizations to confirm this
speculation. |
|
 |
|
 |
 |
|