The patient came to the clinic 02-April-2006 from Iraq complaining of
LBP for 6 years with bilateral sciatica. He was operated at that
time for LCS with relative improvement in the motor function, but
the patient continued to suffer from cauda equina signs. MRI
performed 4 years ago showed still persisting LCS at L5-S1 level.
On examination, the patient had full blown picture of cauda equina
syndrome with hypalgesia below L4 level with dorsi and
planterflexion weakness of both lower limbs and weak abduction both
knees. He was complaining of impotence and micturition and
He was sent for new MRI which showed not only severe stenosis at
L4-5 level, but with central disc at the same level with
sacralization of L5.
The patient underwent laminectomy of the sacralized L5 and L4
with foraminotomy of the left L5 root with removal of the extruded
disc L4-5 from the left side. The ligamentum flavum was adherent to
the dura, to that degree, that it was necessary to sharply dissect
it from the dura, so as to have relaxed walls.
The patient showed immediate postoperative recovery, and the
power of his limbs were complete in the postoperative recovery room.