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26-NOVEMBER-2008 MARYAM AHMAD AQEL 65 YEARS
DE NOVO PROGRESSING LUMBAR CANAL STENOSIS L1-2 WITH OLD PLD L1-2.
Anamnesis:
The patient came to the
clinic 17-November-2008 complaining of flail
both feet for three months with right hip pain
and unable to walk only with walker. The patient was
operated by me
06-July-2003 for lumbar canal stenosis at L2-3,
l3-4 and l4-5.
On examination: the patient
has SLRS right side 80 degrees with pain. She
had weak both quadriceps muscles 4/5 and
bilateral drop feet with weak planterflexion
right 2/5 and left 0/5 with abduction both knees
3/5.
MRI lumbar spine performed
26-October-2008 showing lumbar canal stenosis
above the previous surgery at L1-2 with extruded
disc.
The patient was sent for
another MRI of the lumbar and dorsal spine with
myelography, which confirmed the presence of the
lumbar canal stenosis at L1-2 and the presence
of an old calcified disc at the same level.
Decompressive laminectomy of
D12 and L1 was performed. There was no epidural
fat at these levels. The spinal cord became lax
with transparent dural sheet through which the
spinal cord can be seen.
Inspection of the disc of
L1-2 and the annulus fibrosis revealed that it
is better not to violate the disc space.
Smooth recovery with
some improvement of the right foot power.
FOLLOW UP
The patient
came to the clinic 02-February-2009 complaining of
LBP with bilateral sciatica.
The power of the proximal muscles became full 5/5,
but still drop left foot with weak dorsiflexion
right foot 1/5 and planterflexion both feet 1/5.
The patient
then came 17-April-2012 with same clinical picture
and using walker with LBP the last 4 months
with bilateral sciatica. The patient was sent for
investigation but disappeared.
Comments
The patient has severe
osteoporosis despite the fact that she is under
aggressive antiporosis treatment. This pathology
is the triggering factor for lumbar canal
stenosis combined with the anatomical variation.
The extruded disc was the
triggering point for clinical manifestations,
but it is hard and small in size with shallow
disc space.
Laminectomy of D12 was
performed to prevent possible future progression
of stenosis at the upper level.
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