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
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24-MARCH-2010 GHADA ISMAEEL AL-ARYAN 50 YEARS
PROGRESSING SYRINGOMYELIA OF THE UPPER DORSAL SPINAL CORD.
patient came to the clinic 10-February-2010
complaining of LBP for 27 years after RTA. The
last 2 months exacerbation of LBP with left
sciatica and weak both feet. MRI lumbar spine
done 14-March-2009 showing old wedged fracture
L1 and Th 7 and 8 with syringomyelia starting at
D2 down to D9. MRI dorsal spine performed
19-October-2009 showing progression of the
syrinx. The patient is claiming that her
condition is deteriorating.
On examination: the
patient is dragging her left lower limb. There
is weak grip and extension right hand and
triceps muscle right upper limb 4/5 with
hypalgesia medial side of the right arm. There
is hypalgesia of the right lower side of the
body below D5 with weak muscles left lower limb
3/5. SLRS was 60 degrees in the left due to
weakness. There is Babinski sign both sides. The
patient was sent for new investigations.
MRI of the cervical
spine performed 16-March-2010 was normal,
but MRI of the dorsal spine showed progression
of the syrinx to reach the D1 level.
Laminectomy at D6 level and
opening of the dural sac revealed relatively
healthy spinal cord, for what the laminectomy
was extended up one level and the dural opening
was extended also and the spinal cord was seen
pathologic in the right side of the posterior
surface. At the most affected part of the spinal
cord, using blade No 11 0.1 mm incision was made
vertically. Using the proximal part of
lumboperitoneal tube about 15 cm length the
proximal part of the tube was inserted inside
the syrinx cavity running down and the distal
part running up with small pores created nearby.
The distal part was left in the subdural space
and fixed by nylon 6 zero to the arachnoid to
prevent future slipping of the tube. Applying
pressure to the spinal cord showed good outflow
of the CSF from inside the syrinx. The spinal
cord collapsed. The dura was water-tightly
Routine closure of the wound.
recovery, and the power of left lower limb
Intervention to the static
post-traumatic syringomyelia usually cause
deterioration of the neurological status. But,
when the patient is deteriorating and the syrinx
is increasing in size, surgical intervention is
the only solution to at least halt the
Shunting of the syrinx is
preferable to perform at the most caudal part of
the syrinx, but this is not always possible. The
surface of the spinal cord govern the most
appropriate point of insertion of the shunt, as
in this case.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
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 .