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27-MARCH-2023 AZIZEH HASAN ABU-SIYAM 60 YEARS
SEVERE LUMBAR CANAL STENOSIS L3-4, 4-5 WITH BULGE L3-4 MORE TO RIGHT.
Anamnesis
The patient came to the clinic 16-March-2023 with
LBP and right sciatica
for 6 months and difficult walking and numbness
right foot.
MRI done 20-February-2023 showing
severe lumbar canal stenosis L4-5 and L3-4. CRP
was 4.3 mg/dL, ESR was 59 mm/h and RF 29.2
IU/ml. Dynamic studies showed mild
spondylolisthesis L3-4.
On examination, the patient is in agonizing
pain, limping with exaggerated scoliotic stance.
SLRS was
80 degrees both sides with pain more
in the right side. There is weak dorsiflexion
right foot 4/5.
The patient was sent for investigations and MRI
lumbar spine showed severe lumbar canal stenosis
L3-4 and L4-5 with bulge L3-4 more to the right, dynamic studies
ruled out overmobility. CT-scan of L1-S1 with
ORS Visual was uneventful. Lab investigations
repeated 25-March-2023 showed still high ESR 64
mm/h.
Decompressive laminectomy L4
and L5 with foraminotomy both L4 and L5 roots with
inspection of the annulus fibrosis of L3-4. It
was decided not to violate the disc because
there is no extrusion.
The patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. Prednisolone was
irrigated around the translucent epidural sac
and Xylocain with Marcaine was injected around
the incision. Routine closure of the wound. The power of the
right foot normalized. She was sent to the
ward.
FOLLOW UP
Too early now.
Comments
The sooner the decompression, the better
the outcome in progressive severe stenosis.
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