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25-SEPTEMBER-2010 IZDIHAR RASHEED AL-MASRY 75
YEARS SEVERE LUMBAR CANAL STENOSIS L4-5 WITH MILD SPONDYLOLISTHESIS.
Anamnesis
The
patient came
to the clinic 16-August-2010 complaining of
bilateral sciatica for 3 months and LBP for one
week with numbness both feet. The patient
underwent open heart bypass 13 years ago and
known to be hypertensive for 10 years. She has
bronchial asthma for 15 years, hyperlipidemia
for 10 years and underwent discectomy
lumbar area 28 years ago.
On examination: The
patient swaying when walking and has scoliotic
stance. Romberg was stable. Tinnitus right ear
for 4 years. She
has weak grip and extensors of the right hand and
weak triceps right upper limb. The right foot
dorsiflexion -4/5 and planterflexion 4/5.
MRI of the brain
done 17-August-2010 showing scattered
infarctions both cerebral hemispheres, more in
the left pulvinar and right anterior thalamic
area. MRI cervical area showing cervical
stenosis C4-5. 5-6 and 6-7 with retrolisthesis
at C4-5. The lumbar area showed severe stenosis
L4-5 with elements of spondylolisthesis and
bulge L3-4 and L5-S1. The uric acid was 7.8
and Ferretin level 18.
The patient was sent
for cardio and pulmonary consultation and was
reevaluated accordingly.
Skeletonization of
L4 and upper part of the sacrum. The spinous
process of L4 is stable not movable.
Decompressive laminectomy of L4 and the remnants
of L5. Foraminotomy of both L5 roots.
Bilateral flavotomy of L3-4. The epidural fat
was absent due to severe compression. The right
L5 root was free of adhesions and became free.
The left L5 root was involved with adhesions
from the previous surgery and bony decompression
was achieved. Check for instability was
performed at all stages of the surgery: The
facets of L4-5 were fused by the old
degenerative changes. The disc of L4-5 was
inspected. It was decided not to violate it.
Routine closure of
the wound and smooth postoperative recovery and
the power of the right foot became normal.
Comments
Lumbar canal stenosis is a
progressive disease and the sooner the
decompression, the better the outcome.
The patient have mild degree
of spondylolisthesis. In the plan of surgery
transpedicular screw fixation was considered,
but it was not necessary, because there was no
segmental overmobility.
The patient was lucky, that
she had osteoporotic bone and she did not need
fixation. In case of fixation in such a case,
negative drawbacks could take place in the
postoperative period.
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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 .
