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30-JANUARY-2003 SUHAILA MUHAMED YOUSEF 56 YEARS LCS
L4-5, L5-S1 WITH EXTRUDED DISC L4-5 MORE TO THE RIGHT.
Anamnesis
The patient came to the clinic 20-January-2003
complaining of LBP for 2 years with right
sciatica with numbness left L5 territory. The
patient is hypertensive for 1 year. MRI
lumbar spine done 03-November-2002 showing extruded
disc L4-5 more to the right.
On examination: the patient in agonizing pain,
limping with exaggerated scoliotic stance. SLRS
was 90 degrees both sides. There is almost drop
right foot and planterflexion
right foot 2/5. Analgesia right L5 and
hypalgesia S1 territories.
The patient was sent for investigation and MRI
done the same day showing lumbar canal stenosis
L4-5, L5-S1 with extruded disc L4-5 more to the
right.
Decompressive laminectomy L5,
lower third of L4 and upper edge of the sacrum.
Foraminotomy both L5 and S1 roots. The extruded disc was
attacked first from the right, then bilateral
cleaning L4-5 was achieved. 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 radicular pain decreased and the power of right
foot improved. She was sent to the ward.
Follow Up
The patient came to the clinic 10-February-2003
with slight scoliosis and same sensory deficit,
but slight weak dorsiflexion right foot 4/5.
The patient came several times with the
hypalgesia progressing even to the left left L5
root. MRI performed 10-October-2003 showing
bulge L5-S1.
The patient then came 02-January-2006 telling
that she felt down in October-2003 and she was
operated elsewhere for right CTS 5 months ago
without improvement. MRI cervical spine
performed 06-November-2005 showing cervical
canal stenosis C3-4, 4-5 and C6-7 with malacia
of the spinal cord and OPLL. MRI lumbar spine
performed 31-May-2005 showing mild
spondylolisthesis L4-5. She is diabetic in
treatment for 18 months. She can walk 100
meters. There is neck pain when rotating the
head up and to the right. There is weak grip.
extension right hand and right triceps muscle
4/5 with hypalgesia right ulnar distribution and
the right leg below the knee and the left leg
below the ankle. After that she disappeared.
Comments
The recurrence rate in this case still
ranking around 7% because the disc space is 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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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
