The patient came to the clinic
20-June-2006 complaining of LBP for 20 years. Exacerbation of right
sciatica the last 5 months down to L5 territory with numbness of the
big toe right foot. The patient cannot walk more than 50 meters. LSS
X-ray showing severe degenerative spine with advanced structural
On examination: SLRS was 50 degrees in the right. Weak
dorsiflexion left foot with mild OA both knees. MRI of the lumbar
spine performed 26-June-2006 showing severe LCS L3-4 and L4-5. The
patient is a known hypertensive with diabetes mellitus, for what
cardio consultation was asked and the patient was operated.
Decompressive laminectomy L3-4 was done and despite the fact that
in the MRI, the compression was more evident in the left side, but
during surgery the compression was more pronounced in the right at
the level of L3-4 with black color of the ligamentum flavum at that
level, which could be heamosederin deposition after possible trauma
or degenerated old
ganglion cyst arising from the
right L3-4 facet..
All the compressive elements were treated and foraminotomy of both
L4 and 5 roots was achieved.
Prompt postoperative recovery with improvement of motor power of
the left foot and resolution of shooting right sciatica.
1. MRI of the
spine even in 3 tesla is not all the time showing all the details.
For technical reasons, some elements could be missed and can be
found in the operating table. This fact enforce the idea, that small
hole surgeries has no place in the disc in particular and
degenerative spine in general pathologies.