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03-MAY-2008  NADIRAH TAWFEEQ AL-SAYED  64 YEARS  LCS L4-5 WITH EXTRUDED DISC L4-5 MORE TO THE LEFT.

Anamnesis:

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The patient came to the clinic 22-January-2007 complaining of LBP with left sciatica for three years. Exacerbation the last five months. MRI of lumbar spine done 23-December-2006 showed extruded disc L4-5 more to the left with segmental stenosis at the same level. The patient could walk more than 100 meters with SLRS 70 degrees both sides and weak dorsiflexion both feet 4/5. The patient was treated conservatively.

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The patient then came 30-April-2008 with gross deterioration the last 2 weeks. SLRS was 60 degrees in the right and 40 degrees in the left with weak dorsiflexion right foot 4/5 and left foot 3/5 and inability to walk without aid and severe scoliotic stance.

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MRI performed 02-May-2008 showed severe lumbar canal stenosis L4-5 with extruded disc L4-5 more to the left with total CSF occlusion in MRMyelography.

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Decompressive laminectomy of L4 and foraminotomy of left L5 root was performed. Bilateral inspection of the disc of L4-5 was performed and the extruded disc L4-5 was removed from the left side lateral to the axilla and meticulous cleaning of the disc space was achieved.

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Routine closure of the wound with smooth postoperative recovery.

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Considerable improvement of the power of the left foot.

Comments

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Lumbar canal stenosis is a progressive disease and surgery must be performed the sooner the better, if the clinical manifestations are escalating.

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Lumbar canal stenosis is not a cause for radicular pan, and the cause must be found and resolve, as in this case the extruded disc material, which was compressing the left L5 root.

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