Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
neurosurgery.tv
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13-DECEMBER-2011 SAMIRA AMEEN AL-NASER 62
YEARS LUMBAR CANAL STENOSIS L4-5 WITH WIDE BASED EXTRUSION.
Anamnesis
The
patient came to the clinic 03-November-2011
complaining of LBP with bilateral sciatica for 2
months more the right with numbness left hand
for 5 months and ataxia for 9 years. The patient
is a known hypertensive for 11 years and
diabetic for 30 years in insulin.
On
examination, the patient has shuffling gait
and limping and unable to stand for Romberg
positioning. There is weak upper limb muscles
-4/5 with hypalgesia of the left median nerve
territory. Hoffmann was positive in the left
side with DTR more brisk in the left side.
SLRS was 80 degrees in both sides with pain with
hypalgesia both legs below the knee with almost
drop both feet and weak planterflexion both feet
4/5.
The
patient was sent for investigations, which
revealed PCD C4-5, 5-6 and MRI brain showing
right IC old infarction.
Extended 3/4 laminectomy of
L4 and partial of L5. Bilateral foraminotomy.
The facets were of kissing type and the
ligamentum flavum was adherent to the dura. It
was sharply dissected to prevent tear of the
later. The extruded disc was removed from both
sides and the disc space was empty and shallow.
Routine
closure of the wound. Smooth postoperative
recovery with improvement of the power of
both feet.
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Comments
The patient had collapsed disc space of L4-5
with subsequent severe segmental stenosis.
The estimated recurrence rate in this case is
below 7% because the disc space is shallow.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
