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The patient came to the
clinic 15-November-2006 with left sciatica and
LBP for 2 years with exacerbation of the left
sciatica the last 2 weeks and inability to walk
without help. |
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The patient is a known
hypertensive with diabetes mellitus, rheumatoid
and gout. Total knee replacement was done 2002
and 2006. The patient was limping with scoliotic
stance. |
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On examination: the SLRS was
45 degrees in the left with weak dorsiflexion
left foot 3/5. She had weak muscles four limbs -
4/5. |
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The patient was sent for
investigation: MRI cervical spine performed
16-November-2006 showed PCD C5-6. MRI lumbar
spine showed LCS L4-5 with spondylolisthesis
L4-5 I degree by Meyrding. She had severe
osteoporosis. |
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The patient was given
medications and if she is not improving, then
surgical treatment will be the alternative. |
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The patient then came
03-November-2007 with deterioration of her
condition and heamarthrosis of the left knee due
to heparin overdose for three months. |
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SLRS was 5 degrees in both
sides with drop left foot and the left
knee still swollen. She was bedridden for more
than 6 months. |
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The patient was sent another
time for investigations, which confirmed the
increase of the stenotic component at L4-5
level. |
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Bilateral foraminotomy of L5
roots was performed and preservation of the
spinous processii and interspinous ligament
also. The compressing elements were removed, so
that, all the compressed neural structures were
released and the elements of instability were
not violated. |
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The bone chips were used to
obtain lateral fusion between the transverse
processii. |
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Routine closure of the wound
and smooth postoperative recovery with
improvement of the power of both lower limbs. |
