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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11-OCTOBER-2011 JABER AHMAD ALIYAN 65 YEARS
OSTEOLYTIC DESTRUCTION OF D11 WITH INSTABILITY AND BONY COMPRESSION -
PLASMOCYTOMA.
Anamnesis
The
patient came to the clinic 01-October-2011
complaining of LBP for 8 months with bilateral
sciatica for 5 months. MRI of the spine
performed 06-April-2011 showing wedging of D11.
CT-scan done 17-April-2011 showed osteolytic
lesion of the D1 with involvement of the left
pedicle and the left side of the lamina. Bone
density scan done 26-July-2011 confirming
osteoporosis.
On
examination: the patient using crutches for 3
months, cannot walk to evaluate the
scoliotic stance. There is weak dorsiflexion and
planterflexion both feet 3/5. Adduction and
abduction of the knees and left quadriceps 3/5
and the right quadriceps has 4/5 scale. SLRS was
30 degrees in the right side and 20
degrees in the left due to weakness. There is
paraaneasthesia below D 10, both sides. There is
dripping of urine.
MRI lumbar
spine repeated 03-October-2011 showing severe
compression of the spinal cord at the completely
eroded D11. CT-scan showing that the
adjacent disci are in direct contact.
Bence-Jones protein in urine was negative.
Decompressive laminectomy of
D11 and 12 with partial of D10 was done. The
left half of the D11 lamina and the pedicle were
full of tumor, which was sent for
investigations, which proved to be plasmocytoma.
The tumor inside the body of D11 was also
removed. Part of the tumor was adherent to the
dura and it was coagulated. Through the removed
tumorous left D11 pedicle, 40 cc of Bone-Save
was inserted to fill the empty bone spaces.
Using DepuySpine Expedium system, 2 monoaxial
screws 5x35 mm inserted to the D10. Two screws
5x54 mm inserted to the D12 level. Titanium rods
90 mm length were applied and about 20 mm
distraction was applied. Further impaction of
bone graft was inserted to the body of D11.
Cross Connector was applied for further
stability.
Routine
closure of the wound. Smooth postoperative
recovery with slight improvement of the power of
both legs.
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Comments
The patient has neglected plasmocytoma. which
eroded most of the body of D11 during the 8
months period. If the patient was diagnosed
early, the surgery was mostly un-needed.
The Bence-Jones protein was negative, but the
patient has plasmocytoma, for what MRI
spectoscopy is very powerful, to resolve such
conflict.
Postoperative check CT-scan with screw fixation
and bone grafts.
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 .
