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21-DECEMBER-2003 NAZIRA IBRAHEEM SAYF LUMBAR
CANAL STENOSIS L3-4, 4-5, L5-S1 WITH CALCIFIED EXTRUSION L5-S1 LEFT SIDE.
Anamnesis
The patient came to the clinic
15-November-2003 complaining of LBP and
bilateral sciatica for 4 years. He is a known
hypertensive for 6 years under treatment.
On examination: the patient
is unable to walk, using crutches for 15 months
with scoliotic stance and limping. SLRS was 40
degrees both sides without pain. There is severe
weak dorsi and planterflexion both feet, more
the right with hypalgesia both L4.5 and S1 roots
territories both sides.
The patient was sent for
investigations and MRI lumbar spine showed
lumbar canal stenosis L3-4 and L4-5 with
calcified extrusion L5-S1.
Laminectomy L4, L5 upper edge
of the sacrum and lower third of L3. Foraminotomy
right
L5 and S1 roots. Inspection of
the disci was negative for violation. The
patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. A free fat was
harvested from the subcutaneous layer and
covered the exposed parts of the root. to
minimize postoperative scarring. Routine closure
of the wound. Smooth postoperative recovery. The
power of the feet slightly improved.
FOLLOW UP
The patient
came to the clinic 02-January-2004 with clean wound
with more improvement of the power of both feet.
Comments
The sooner the
decompression in progressive lumbar canal
stenosis the better the outcome.
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Notice: Head injuries and very urgent surgeries are also
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