The patient came directly to the
hospital with clinical history of complete paraplegia below L3 level
for 3 weeks. He had previous attacks of LBP for several years and he
underwent excision of sacral coccyadenitis 7 months ago.
MRI performed showing severe LCS L3-4 L4-5 and
extruded disc L3-4 with tethered cord syndrome. The patient had
complete loss of sensation of the left foot with hypalgesia of the
other below knee with the paralysis complete in the right more than
the left, resembling Brown-Sequard syndrome, but complete drop both
feet and qauda equina syndrome is the main clinical picture. He had
micturition problems 3 weeks ago, with slight improvement.
The patient underwent surgical decompression of
L3-4 laminae and the upper sacrum, which in reality is the L5
lamina. Removal of the L3-4 disc extrusion was performed from the
right and inspected from the left. Foraminotomy of both L4, L5 roots
was performed. Considering that the filum terminale regained at
least 5 mm relaxity after the decompression and annulation of the
angulation, it was decided not to untether the cord, since he is 38
years age and he never complained of it previously.
The patient came to the clinic 19-February-2006.
The wound was clean and the hypalgesia was restricted to the left L5
root territory with regaining full power of the right foot and the
power of the left foot planterflexion was 4/5, but still drop left
foot. Urination and defecation were normal and he can walk with aid
of one person.
It is rare to see such a case with all these data
gathered to cause paraplegia. It was decided before the surgery to
perform untethering, but after achieving decompression, this plan
was omitted, because of his age and the extra-relaxation of the cord
obtained by eliminating the angulation at this area.