View Poll Results:
- 2. You may not vote on this poll
Here are the exams before and after surgery
July 3, 1998; fx C1-C2 and fx luxation T5-T6 complete paraplegic, fixed with Harrington rod C7-T10
July 31, 1998; fusion C1-C2 by lateral approach and by two screw ostÃ©osynthÃ¨se pestered according to the technique of Dutoit
October 16, 2001; MRI Cervical and dorsal
Nevertheless, one notices a syringobulbie getting(touching) all the cervical spinal cord and which at the dorsal level extends credibly in a continuous way until the level T11-T12, at once upstream to cobare. On all the length, there is thus release(extension) marked with the spinal cord which fills(performs) almost completely the spinal canal especially until the level T6. On the other hand, the spinal canal is of good calibre at all the studied levels. There is no pathology considerable loss of weight. One notes osseous reorganizations post traumatic in T5-T6.
November 13, 2001; Surgery on MontrÃ©al Neurogical Institute
Proposed Operation; Insertion of syringopleural shunt, right side.
After induction of anaesthesia, a Foley catheter was inserted previously. The patient was placed in the prone position with a Mayfield clamp to hold the head in the fixed position. The patient was prepped and draped in the usual fashion. Wide draping was used to include the area of the neck and the area of the subscapular area.
A midline incision through the cervical region in the skin and subcutaneous tissue was deepened down to expose the supraspinous process of C4-C5. Using a Cobb and unipolar diathermy, the muscles were retracted laterally and released from the supraspinous processes and laminae bilaterally distal to the facet joint.
After that, a high-speed drill was used to drill the laminae. The cortex and the spongy parts of the laminae were removed from both sides, and then the laminae of C4 and C5 were removed, exposing the thecal sac.
Following that, attention was directed towards the right posterior part of the subscapular region. An area of T7 was exposed. The skin incision was done over the T8 rib. The skin and subcutaneous tissues were opened. A self-retaining retractor was placed, and then with layer by layer dissection, the parietal peritoneum was exposed and opened. The reduction again was directed towards the area of the cervical spine. A shunt tube was inserted using a shunt guide inserted through the cervical opening up to the incision at the subscapular area. The shunt tube was passed through the guide and then the guide removed. Prior to that, the shunt was tested for function and was functional.
Using a dural hook and the 15-blade, the dura was opened in the middle, and then using micro scissors, the rest of the dura was opened caudally and cranially, exposing the spinal cord. The dura was held in position with 5-0 Nurolon stay sutures. After securing haemostasis, the area of the dorsal root entry was localized. Small veins were cauterized, and using a Rhoton No.6, a small opening in the spinal cord was done. The syringomyelia cavity was identified. The tube was inserted into this cavity and was fixed into the dura using 3-0 Nurulon. The rest of the dura was closed using 4-0 Nurulon in continuous fashion. A leak was adjusted by a Vasalva manoeuvred at 14 millimeters or mercury and was watertight.
The attention was directed again towards the chest area. The tubing was placed into the pleural cavity. The wound was closed in layers, starting with 3-0 Vicryl for the subcutaneous tissue and fat and finally the skin using 3-0 Nurulon in continuous locking fashion. The cervical wound was closed first of all. The muscle was approximated using 0 Vicryl. The fascia was approximated using figure-of-eight 0 Vicryl. The subcutaneous tissue was closed with 3-0 Vicryl. Finally, the skin was closed with locking continuous 3-0 Ethilon. A dressing was applied.
The patient was sent to the Recovery Room after extubation in good condition moving all limbs. A chest x-ray was to be ordered postoperatively.
November 13, 2001; Diagnostic Radiology/MRI; Chest portable
Finding; A small catheter is seen in the right hemi thorax. The lungs are clear
November 13, 2001; Pathology Report
Specimen received; Bone
Gross description; The specimen is labelled `bone` and consist of two pieces of bone
Final diagnosis; Tissue compatible with bone
November 27, 2001; Diagnostic Radiology/MRI; MRI; Cervicothoracic and lumbar spine
Technique; Multi-planar, multi-sequential images were performed for the evaluation of the cervical, thoracic and lumbar spine
Finding;MRI cervicothoracic spine; The examination is disturbed by the presence of multiple artifacts created by metallic band in the back of the patient. At the cervical level, there is evidence of syringomyelia. I have the impression that the syringomyelia extends at least to the upper thoracic region but again the visualization of this portion of the spine is limited due to the presence of artifacts previously described.
Finding, MRIlumbar level; The conus medullaris is normal. Evidence of a hemangioma of the vertebral body at L3. No evidence of major compression on the dural tube.
Conclusion; Limited examination due to the presence of artefacts created by the Harrington rod. Syringomyelic cavity is noted at the cervical and upper thoracic region. No previous films are available for comparison.
December 06, 2001; Diagnostic Radiology/MRI; MRI; Brain and cervical spine with Gadolinium
Reason; Post syringo-pleural shunt with attack of left arm needles, with some difficult breathing. ?brainstem abnormality
Technique; MRI cranio cervical junction including from fourth ventricle to cervical spine routine protocol with Gadolinium.
Finding; There is no apparent brainstem abnormality. The spinal cord does not appear impinged upon at foramen magnum and C1-C2. The syrinx is seen in the cervical cord not significantly different from November 27, 2001.
June 19, 2002; MRI; Cervical and dorsal
Reason; Shunt for syringomyÃ©lic in November, 2001. Re-evaluation. Trauma with hooping C1-C2 and fusion D1-D10
Technique; There was obtaining of sagittal cups(cuttings) T1 and T2 of the foramen magnum to L1 and balanced cross sections T2 of the occipital hole to D3
Finding; At the level of the occipital hole, there is no evidence of compression of the spinal cord. In spite of the presence of artifacts generated by saw them metal in C1-C2 and the postÃ©ro-lateral stalks Harrington fixed in D8 , D9 and D10, one shows a syringomyÃ©lic cavity beginning as high as C5, implying as well the dorsal marrow until D11. Towards C7-D1, this cavity is of the order of 1 cm in diameter and of 5 mm of D6 to D11. Compared with the cranio-cervical magnetic echo practised on December 6, 2001, this cavity seems more prominent. Cobare is in position and of appearance normal and there is no other detectable abnormality.
My neurological loss (sensory or motor) located on the left side and still remain. And since my surgery I noted increase burning located in shoulder blades and left arm. From the shoulder to the fingertips a pressure or blow on my arm is unbearable. Atrophy of the fingers and lost flexibility. I need medication of dilaudid 1-2mg /day before bedtime to reduce bad sensation like million needles on the left arm. Weakness and pain on my arm.
Here is my question
I read a lot on this subject via this forum and the shunt technique usually helps for a year or two but the catheters almost invariably occlude and stop shunting the fluid. Many people required repeated surgeries in over 80% of the patients. If my shunt occlude and stop shunting the fluid can I have surgery like Dr.Bart Green proposed by simply removing the adhesions between the spinal cord and the dura, to prevent re-adhesion, and eliminate the cyst and in the same time remove my Harrington rod.?
I live in MontrÃ©al, QuÃ©bec I need to know if this technic exist around here if not I'm ready to fly to Miami and meet Dr. Bart Green