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16-DECEMBER-2003 ABDEL-RAHMAN AL-GHAWI 67
YEARS LUMBAR CANAL STENOSIS L3-4, 4-5 WITH BULGING DISC L4-5.
Anamnesis
The patient came to the clinic
10-November-2003 complaining of LBP and
bilateral sciatica for 18 months. He is a known
diabetic and hypertensive for 5 years under
treatment. H has essential tremor left hand.
On examination: the patient
is unable to walk, using crutches for 5 months
with scoliotic stance and limping. SLRS was 50
degrees both sides without pain. There is severe
weak dorsi and planterflexion both feet, more
the right with hypalgesia both L4.5 and S1 roots
territories both sides.
The patient was sent for
investigations and MRI lumbar spine showed
lumbar canal stenosis L3-4 and L4-5 with bulge
L4-5.
Laminectomy L4, upper third
of L5 and lower third of L3. Foraminotomy both
L4 and L5 roots in the right side. Inspection of
the disci was negative for violation. The
patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. A free fat was
harvested from the subcutaneous layer and
covered the exposed parts of the root. to
minimize postoperative scarring. Routine closure
of the wound. Smooth postoperative recovery. The
power of the feet slightly improved.
FOLLOW UP
The patient
came to the clinic 16-November-2003 with clean wound
with more improvement of the power of both feet.
Comments
The sooner the
decompression in progressive lumbar canal
stenosis the better the outcome.
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Notice: Head injuries and very urgent surgeries are also
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