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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19-JUNE-2012 HAKAM GHANEM AL-ATELY 52 YEARS TUMOUR
OF THE D9 WITH SEVERE COMPRESSION OF THE SPINAL CORD WITH OLD FRACTURE L1 WITH
The patient came to
hospital 14-June-2012 from Qatar with
undiagnosed mid back pain for one month with
exacerbation the last 10 days with agonizing
pain when walking and numb both lower limbs.
Chest CT-scan and US both kidneys were done
06-June-2012 and were reported normal. LSS X-ray
done 08-June-2012 showing old wedge fracture L1.
CT-scan done in improper way suggesting fracture
of D9. The patient denying suffering major
trauma and he mention that he suffered minor car
accident one month ago. The patient had bullet
injury 32 years ago and left thoracotomy was
done at that time.
examination, the patient is bedridden refusing
to walk. SLRS was 90
degrees both sides. There is weak dorsiflexion
both feet 4/5. Before surgery there was weak all
muscles both lower limbs -4/5.
Bone scan done 16-June-2012 showing high uptake
in the region of D9 and the 5th right rib. MRI
dorsal spine with contrast and myelography
showed a tumor of the D9 with severe compression
of the spinal cord and destruction of the bony
alignment and the mass filling the canal and
reaching the anterior border of the D9 body. MRI
lumbar spine also showing severe canal stenosis
at L1-2 level. ESR was 5 mm/h and Bence-Jones
protein in urine was negative.
Using Inomed tumor dorsal
spine protocol, skeletonization D7-8-9-19-11 was
done lateral to the ribs. Laminectomy of D9 and
lower half of D8 was done to expose all the
borders of the tumor. The right Th9 root was
severely involved with tumor which was pushing
the spinal cord posterior. The soft part of the
tumor was removed subtotally with preservation
of the right root. FF biopsy gave the answer for
plasmocytoma and did not ruled out lymphoma.
The body of D9 was relatively preserved and in
good shape after removing the tumor and it was
decided to leave the body in place without
violating it. Using Medtronic LEGACY FAS 6.5 x40
mm for Th 10 and Th8 and 6.5x45 for Th11 and
5.5x40 mm for Th7 transpedicular screws with
bended rods 5.5 mm diameter and CrossLink
multispan 322 were used to fused Th7-Th11.
BCP bone graft 20 cc granules were used lateral
to the rods and Th9 level. All stages of surgery
were done using image-intensifier and ISIS
Routine closure of the wound. Smooth
postoperative recovery with normalization of the
power of the lower limbs.
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The patient has tumor
compressing the spinal cord threatening eminent
plegia. Surgical interference must be performed
regardless of the tumor nature.
Coporectomy was not necessary in this case,
because the shape of the body was acceptable.
The patient came for
follow up 05-February-2014 and check MRI showing
resolution of the tumor. The patient was
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 .