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17-AUGUST-2003 MARIYM ABDEL-KAREEM GHANEM
60 YEARS RECURRENT PLD L4-5 WITH SEVERE STENOSIS.
Anamnesis
The patient came to the clinic
07-April-2003 complaining of LBP for 30 year with
right sciatica. She was operated at Al-Bashir
hospital 18 months ago for PLD? without
improvement. MRI
lumbar spine done 16-April-2001 showing severe
lumbar canal stenosis L4-5 with PLD l4-5. MRI
repeated 16-June-2002 showing the same data.
On examination, the patient is limping with
exaggerated scoliotic stance. SLRS was 75
degrees both sides with pain. There
is flail right foot and severe weak dorsi and
planterflexion left foot2/5. The patient has OA
both knees with edema and increased temperature
left knee.
The patient was sent for investigation and MRI
showed the same data.
Decompressive laminectomy
L4-5 with
foraminotomy both L5 roots after removal of the
scars and repair of the defective dura by nylon
6 zero. The extruded disc was
removed lateral to the both axillae and
bilateral intradiscal cleaning L4-5 was achieved.
Osteophytectomy of the bony extrusion was
achieved by drilling. The patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. Routine closure of the wound.
Smooth postoperative recovery.
The patient showed improvement of the power of
her both feet.
She was sent to the ward.
FOLLOW UP
The patient
came to the clinic 30-August-2003 with clean wound.
SLRS was 80 degrees both sides without pain, but there
is
weak planterflexion right foot 4/5 and no sensory
deficit.
The patient
then came 04-October-2003 with slight weak
planterflexion right foot with dysesthesia right S1
territory.
The patient
came to the clinic 30-January-2005 with neck pain
with weak grip, extension right hand and right
triceps muscle. MRI cervical spine performed
10-May-2005 showing severe spinal cord compression
at C3-4 and C5-6. The patient having many health
issues and nagging and not following
recommendations, for what I decided not to follow
her anymore since 11-September-2006.
Comments
There is still an estimated postoperative
recurrence less than 7%, because the disc space
is shallow, but not completely collapsed.
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Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
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After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
