The patient was operated by
other neurosurgeon 02-September-2008 for left
sciatica. The patient came to the clinic
25-March-2009 with clinical deterioration the
last three weeks. The patient using crutches for
6 years for complicated fracture of the right
lower limb with infection.
On examination: the patient
could not be evaluated for Romberg position and
SLRS was zero in the right due to old Polio and
60 degrees with pain in the left. The patient
had weak all muscles right upper limb 4/5 and
extension and left triceps muscle 4/5. He had
almost drop right foot with weak planterflexion
right foot and dorsiflexion left foot with
abduction both knees 3/5 and adduction of the
lumbar spine, which was done 14-December-2008
which showed stenosis at L3-4 and L4-5 with
ganglion from the left L4-5 facet joint
compressing the left L5 root.
The patient sent for another
MR investigations, which confirmed the presence
of malacia of the spinal cord at C5-6-7 level
without apparent compression. He had scattered
old infarctions both cerebral hemispheres.
The patient was treated
conservatively and he showed improvement and
came to the clinic 29-April-2009 with
improvement of both upper limbs and the left
lower limb with regression of the left sciatica.
The patient had severe OA both knees and he was
sent for orthopedic consultation.
The patient then came
12-May-2009 with agonizing left sciatica for 4
days with numbness of the left foot.
On examination SLRS was zero
in the right (Polio) and 30 degrees in the left
with pain. He had dramatic deterioration of the
power of the left foot. MRI lumbar spine
performed 15-May-2009 showed recurrence of L4-5
left side with severe compression of the left L5
root with huge cyst below the axilla of L5 root
reaching the level of L5-S1.
The wound was refreshed and
the right corner of L4-5 was skeletonized.
Foraminotomy of left L5 root was achieved and
laminectomy of L4 was performed. The old
gangliotic deformity of the left L4-5 facet was
removed and the extruded disc of L4-5 was
removed lateral to the axilla. The nerve was
pushed anteriorly. Inspection of the axilla from
the underside showed fluidic cyst compressible
and mostly due to old localized infection and
with CSF content. All attempts were directed to
avoid its rupture. The root was lax and
meticulous cleaning of the inflamed disc
material of L4-5 was achieved.
Smooth postoperative recovery
with disappearance of left sciatica.