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05-AUGUST-2007 TAGHREED MUHAMED DIYAB 37 YEARS RESIDUAL AFTER POSTOPERATIVE
CAUDA EQUINA SYNDROME AFTER DISCECTOMY L4-5.
Anamnesis
The patient came to the clinic 20-May-2007
complaining of difficult walking with left
sciatica and progression of cauda equina
syndrome with loss of defecation and micturition
sensation after discectomy performed
18-December-2007 elsewhere. She was reoperated
25-December-2007 elsewhere without
improvement.
MRI performed after fist surgery showing
recurrence and the one performed 19-April-2007
showing another recurrence.
On examination: the patient is limping with weak
dorsiflexion both feet 3/5 and planterflexion
4/5 and hypalgesia both L5 roots and cauda
equina syndrome with loss of defecation and
micturition sense.
Revision of the wound was performed and all the
stenotic elements at L4-5 level was eliminated
and foraminotomy of left L5 root was performed
and the remnant of the extrusion was removed and
meticulous cleaning of L4-5 disc space was
achieved. The L5 lamina was mobile and that
mobile segment was removed.
Smooth postoperative recovery. The power of both
feet improved immediately after the operation,
but the bladder and defecation problems still
the same.
Comments
The patient is undergoing the third operation
for complicated status.
The considerable improvement of the power of
both feet is a good sign for future recovery of her defecation
and micturition drive.
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