The patient was operated by me 29-March-2016 for TB osteomyelitis. The power of four limbs became better, but she was transferred fro the pulmonary center in Irbid due to slipped left inferior part of the fixating device with skin defect over this part of the construct.

On examination: the patient walking neurologically is better than before with dramatic improvement of the power, but the sensory defect still the same.

The patient was sent for cervical and dorsal X-rays, which gave little information.

The lower end of the wound was refreshed and extended down to expose 2 dorsal laminae. Both rods were slipped. The right most inferior hook and the left 2 hooks with fracture of the left lamina, which was supporting them. The right hook was reduced to its previous location and secured. The 2 hooks in the left were removed and one of them was used to hang at the inferior edge of the lower healthy lamina left side. This point was aided with sublaminar wires of titanium and stainless steel wire doubles to avoid traction fracture of the lamina.  Routine closure of the wound. The lacerated wound was debrided and cosmetically closed.

Smooth postoperative recovery. She was sent to the ward.

The patient showed dense plegia below D4, despite the fact, that no gross manipulations were performed intradurally. The sublaminar wire was accurately inserted as intended and the hooks were inspected accurately. The most reasonable cause is the functional over irritation applied to the spinal cord during reduction of the fractured spine.  The patient the next day before transferring her started to show mild contractions of the adductors both hips. The wound was clean. The patient was sent back to the Pulmonary Center in Irbid for financial reasons.

After several communications with treating doctor in Irbid, it became clear that the patient has ulcerative colitis for several years and receiving Imuran, cortisone. She is still in these medications and her low immunity from these drugs, caused the tbc and the subsequent catastrophic events.

The patient performed CT-scan of the area 14-July-2016 demonstrating that the construct is acceptable and circulage or the the sublaminar wire is in place. The patient was very aggressive that it was impossible to examine her. But during that I noticed dramatic improvement of the upper limbs. The accompanying nurse showed the list of drugs, she is receiving: There more than 15 drugs among them cortisone and Imuran. There were tiny scattered wounds with fungal infection, for what she is receiving treatment for that and I suggest to increase the anti osteoporotic treatment and to undergo IV/IG to elevate her immunity. 

During the first surgery, the possibility of such complication was taken into consideration, for what maximal preservation of bony elements and a lot of fixating points were achieved. Despite these precaution slipping of the left inferior part of the device was noted 2 weeks after the performed surgery.

If the patient has tbc and ulcerative colitis with still under treatment of chemotherapy and cortisone, it is wise to avoid such surgery, because the patient still up to now exposed to more serious catastrophic events elsewhere in the various systems.