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30-AUGUST-2004 AMIRA ABDEL-FATAH ATIYAT 46
YEARS LUMBAR CANAL STENOSIS L4-5 WITH RIGHT LATERAL RECESS SYNDROME.
Anamnesis
The patient came to the clinic 25-August-2004 complaining of LBP for
7 years with right sciatica and numbness both
feet the last year and intermittent claudication
and inability to walk more than 50 meters. MRI
done the same day
showed severe stenosis
L4-5.
On examination: The patient is limping with
exaggerated scoliotic stance. SLRS was 50
degrees in the right and 60 degrees in the
left with pain. There is
weak dorsiflexion both feet 3/5 with hypalgesia
both L5 and S1 territories.
Decompressive laminectomy
L4-5 with foraminotomy
both L5 roots with
inspection of the disc from the right. It was
decided not to violate it.
The patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. A fat in pedicle was
transferred from the subcutaneous layer and
covered the exposed parts of the dura and roots
to minimize postoperative scarring. Routine
closure of the wound. Smooth postoperative
recovery. The power of both feet became
normal.
She was
sent to the ward.
FOLLOW UP
The patient came to the clinic 11-Septmber-2004
with clean wound and SLRS 80 degrees both sides
without pain and neurologically free.
Comments
The sooner the decompression on progressing
lumbar canal stenosis, the better the outcome.
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Notice: Head injuries and very urgent surgeries are also
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