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The
patient a Sudanese Professor in Arabic language came to the clinic
23-May-2011
complaining of LBP with left sciatica for 3
months after turning his trunk. The
patient also complaining of tremor both hands
more the left for 4 months. He has memory
disturbance for 5 years. The last 2 months has
difficulty in producing loud voices. The patient
felt down 20 months ago and got stable fracture
of L1, treated conservatively. The patient is a
known diabetic under treatment for 16 years. He
has arterial hypertension for 7 years. He had
head injury 1984 with old cut wound in the
forehead left side. |
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MRI of the
brain and lumbar
spine performed several times showing widened
ventricular system with scattered tiny lacunar
infarctions periventricular. He had wedge
fracture of L1 which increased over the time,
but stabilized the last year. MRI lumbar spine
performed 06-April-2011 showed the wedge
fracture of L1, which was seen in all previous
MRI studies and extruded disc L4-5 with left
foraminal occlusion which was not noted in the
previous investigations. |
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The
patient was sent for new investigations which
confirmed the presence of the extrusion L4-5
with complete occlusion left L4-5 foramen. The
old fracture of L1 is the same and simple X-rays
confirmed the presence of calcifications of L1
and D12. There is mild stenosis of left
ICA with tortuous arteries. with same scattered
lacunar infarctions as seen before. |
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On
examination: the patient is limping with
exaggerated scoliotic stance and swaying to the
left when walking. SLRS was 70
degrees with pain in both sides. There is weak
dorsiflexion left foot 3/5. There is severe OA
both knees without pain. |
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Left L1 foraminotomy with exposure of the
subaxillary area 10 mm below the axilla. The
extruded disc was removed lateral to the axilla
and left sided cleaning of L4-5 disc space was
achieved. |
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Routine
closure of the wound. The sciatica
disappeared and the power of the left foot
regained full power. |
