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The patient came to the clinic 23-March-2005 complaining of
LBP for 10 years with intermittent bilateral sciatica for 6 months,
more the right. He could walk 500 meter. He is blind in the left eye
since childhood. MRI of the lumbar spine performed 06-March-2005
showed mild stenosis at L2-3, L3-4 and D11-12. On examination:
he had no neurologic deficit and he was advised to be treated
conservatively. The patient then came 29-October-2006
complaining of exacerbation of LBP with bilateral sciatica the last
4 months and he could not walk more than 100 meters with
intermittent claudication. He had weak dorsi and planterflexion
right foot with hypalgesia of right S1 root territory. MRI of the
lumbar spine with MR Myelography were performed 13-November-2006
showing severe LCS L2-3. L3-4 and L4-5 with bilateral lateral
recess syndrome.
Decompressive laminectomy of L3,4 and partial of L2 and L5 was
performed and bilateral foraminotomy for L3, L4, L5 roots was
achieved. It was noted that the patient had transverse fracture of
the medial facets of L2 both sides, but the construct was stable.
The loose fragments were removed.
Comments:
1. LCS is a progressive disease and when the patient start to
have progressive neurologic deterioration, surgery must be performed
to prevent further deterioration.
2. The cause of the transverse fracture, which seems to be a
new one, could be due to vigorous physiotherapy. Check for
instability must be performed to insure that fixation is not
required, as in this case.
3. Drilling help during the surgery and lower the surgical
trauma to the already compressed neural tissues. |
