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The patient came 27-August-2006 complaining of LBP for 4 months with
bilateral sciatica , more the right and inability to walk more
than 20 meters with intermittent claudication. The patient is
under treatment for lupus with prednisolone 5 mg for 10 years,
with hypertension for 4 years, hypercholesterolemia and
diabetes mellitus for 4 years and in L-thyroxin 50
microgm daily for 5 years. MRI done 28-June-2006 showing
severe LCS L4-5 with minimal stenosis L3-4. On
examination: the patient had weak dorsi and planterflexion both
feet, more the right with atrophy of both gastrocnemius muscle both
forelegs and severe OA both knees. Weak knee abduction 3/5 both
sides.
Decompressive laminectomy L4 and partial of L3 and L5 was
performed and foraminotomy of both L5 roots was achieved. Inspection
of the foramina for any residual compression was negative and the
L4-5 disc was inspected and it was glistening without any extrusion.
Prompt postoperative recovery.
Comments:
1. It was explained to the patient, that she has plenty of medical
problems, which cannot be resolved by surgery. Since the LCS is a
progressive one; this part of her many problems must be corrected by
surgery to prevent further deterioration caused by this severe
stenosis.
2. Considering that the patient has many problems and cortisone can
lead to further escalation of the stenosis at the above level,
decompression of L3-4 was corrected to prevent further surgery in
the near future. |
