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
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30-OCTOBER-2008 UMAR MUHAMED AL-TURK 58 YEARS
LUMBAR CANAL STENOSIS D12-L3 WITH EXTRUDED DISC L2-3 CENTRAL MORE TO RIGHT.
Anamnesis:
The patient came to the
clinic 22-October-2008 complaining of numbness
both feet for 2 years. !8 days ago, the patient
after bending in the toilet, got LBP and left
sciatica with dyseasthesia lateral aspect
left thigh. Later he progressed right sciatica
with numbness all toes right foot.
The patient was operated 28
years ago for PLD L4-5 by using grafts lateral
to the spinous processii. The patient was
suspected to have renal failure four
months ago and was put in treatment with
cortisone for three months and he was treated
for diabetes mellitus. He was also under
treatment for hypertension with Atakand and
Zestril.
On examination: the patient
is limping with exaggerated scoliotic stance,
bending forward
with SLRS 85 degrees in both sides with pain and
drop right foot and weak planterflexion
right foot 4/5. There is also weak dorsiflexion
left foot 3/5 and knee abduction 4/5. Hypalgesia
of right L5 and S1 territories. There is urgency
and frequency for the last 4 days.
MRI lumbar spine was
performed 24-October-2008 showing severe lumbar
stenosis starting from D12 down to L3 with
central more to right extrusion of L2-3.
The patient was admitted one
day before surgery and monitoring ruled out the
presence of diabetes mellitus and he had
profound hypotension due to suprarenal
depression induced by cortisone. It was
necessary to give him cortisone to elevate his
blood pressure.
Decompressive laminectomy of
D12, L1, L2 and partial of L3 was done. The
extruded disc of L2-3 was attacked from the
right and removed and meticulous cleaning of the
disc space was achieved from the left side. The
epidural fat was absent at all exposed level.
Smooth recovery with slight
improvement of the power of the left foot. The
drop right foot still the same but
planterflexion improved.
Comments
The patient has severe
compression of the spinal cord at D12-L1 level
with malacia. Recovery of this part will
determine the whole outcome of the patient.
The patient underwent fusion
of L3-4-5 by using bony grafts parallel to the
spinous processii 28 years ago. The
patient claim that he improved after such
surgery, for what the old extrusion of L4-5 was
not violated. This maneuver could be the cause
of his recent escalation of the PLDs at
these high levels D12-L1 and L2-3, because the
stress points migrated upward.
The expected recurrence rate
in this case is below the average, because the
disc space height shallow.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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