The patient was seen 09-January-2006 complaining of LBP for 4 years
with exacerbation of the pain and bilateral sciatica the last year.
Numbness both feet for 5 months and inability to walk more than 200
meter without intermittent claudication. He is a known
hypertensive for 4 years. He has also gout and underwent stinting
for cardiac problems in April-2004.
On examination, he had
hypalgesia of the right foot with hypalgesia of the left lower limb
up below the knee. He had weak dorsiflexion both feet and
planterflexion left foot. MRI was performed 05-July-2005 showing LCS
L3-4 and D11-12. The patient was sent for another MRI and the
stenosis was not striking at L3-4 with elements of stenosis at L1-2
and L2-3. The stenosis at D11-12 was due to old disc extrusion in
the right side.
The patient was advised to undergo conservative treatment and to
be followed. In case of deterioration, then surgery to be performed.
The patient came 22-March-2006 with marked deterioration of his
neurological signs with cauda equina syndrome and hypalgesia below
the knees both sides and micturition problems for 2 days.
Laminectomy of L2-3 and partial of L4 and 1 was performed and
foraminotomy of both L2-3-4 roots was achieved. Decompression was
done at the all mentioned levels. The old extrusion at D11-12 was
checked by inserting feeding tube No 10 to rule out the presence of
any resistance. The impression was negative. Routine closure of the
Smooth postoperative recovery. The patient the next day showed
normalization of the power of both lower extremities and recovery of
sensation of the right lower limb with decrease of the sensory
deficit to the left foot.