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12-SEPTEMBER-2002 WAJDI JAMIL AL-IKER 62
YEARS LCS L2-3, 3-4, 4-5, L5-S1 WITH EXTRUDED DISC L4-5 RIGHT SIDE AND
L5-S1 LEFT SIDE.
Anamnesis
The patient came to the clinic 05-September-2002
complaining of LBP for 15 years with right
sciatica and weak both lower limbs. Exacerbation
of the condition with left sciatica. MRI lumbar spine recently
done showing lumbar canal stenosis L2-3, 3-4,
4-5.
On examination: The patient in agonizing pain,
limping with exaggerated scoliotic stance.
SLRS
40 degrees both sides with pain. There is severe weak
dorsi and planterflexion both feet 3/5, with hypalgesia
left leg below L2 dermatome.
The patient sent for investigations and dorsal
MRI was uneventful and has severe lumbar canal
stenosis L2-3, L3-4, L4-5 and L5-S1 with
possible extrusions.
Decompressive laminectomy L3,4,5 lower third of
L2 and upper edge of the sacrum.
Bilateral L3, 4, 5 and S1 foraminotomy both sides.
Inspection of the disc revealed extruded disc
L5-S1 left side, which was removed and left
sided cleaning L5-S1 was achieved. Discectomy
L4-5 from the right with right sided intradiscal
cleaning L4-5. 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 power of both feet improved.
He was sent to the ward.
Follow Up
The patient came to the clinic 26-September-2002
with clean wound and still having slight
weakness dorsiflexion right foot with the
hypalgesia regressed to the medial aspect of the
lower third of the left foreleg. SLRS was 80 degrees without pain
both sides.
The patient then came 27-October-2002 telling
that he still have right sciatica with
difficulty in walking. SLRS was 45 degrees right
side and 35 degrees left side without pain. The
power of both feet normalized, but the right
quadriceps was 4/5. with hypalgesia left L5 and
S1 territories. He was treated conservatively.
The patient then came 19-November-2002 still
complaining of right sciatica and weak right
quadriceps femoris 4/5 with SLRS 70 degrees both
sides without pain.
Comments
The sooner the surgical decompression in
progressive LCS, the better the outcome.
The patient has also extruded disci with
recurrence rate postoperatively around 14%.
In retrospective analysis of this case,
it was preferable to make check MRI and dynamic studies and
in case of new events to make the appropriate intervention.
(28-April-2021).
Our policy at the present time (2020),
when we do discectomy in lumbar spine for 2 adjacent levels,
transpedicular fixation is a must.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
fixation is the most accurate system in the market. The microdrive and
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Inomed MER system
Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
LooksCam II Xenosys in the run starting from 14-March-2021 with
SheerVision TTL x4 magnification.
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 .
