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11-APRIL-2010  MUHAMED NOOR LUTFI AL-ATTAR  65 YEARS  LUMBAR CANAL STENOSIS L3-4 AND L4-5 WITH BILATERAL EXTRUSION OF L4-5.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Inomed ISIS 32 channel Highline Functional Neuronavigtion.

Anamnesis

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The patient came to the clinic 07-November-2007 complaining of LBP for 2 months  with right sciatica. MRI done 03-Nevember-2007 showing lumbar canal stenosis L4-5 with right far lateral extrusion and wide based extrusion of L3-4. The patient is a known diabetic insulin-dependent. There was weak dorsiflexion right foot 4/5. The patient was advised to undergo conservative treatment and he improved.

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The patient then came 28-March-2010 complaining of LBP with bilateral sciatica more the left for more than 1 year, reaching the ankles. The patient could walk more than 1 Km .

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MRI lumbar spine performed 12-March-2010 showing severe lumbar canal stenosis L3-4 and L4-5 with bilateral recess syndrome.

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On examination: the patient has weak dorsiflexion left foot 3/5 and right foot 4/5. The patient now is under Caduet for 2 years for arterial hypertension.

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Decompressive laminectomy L4 and partial of L3 and L5 was performed and the annulus fibrosis of L4-5 was checked for fresh extrusion. It was negative both sides. Foraminotomy of the right L5 root was performed easily, but it was necessary to extend it for 17 mm along the left L5 root to achieve acceptable release. Using the pedicle protocol of ISIS Inomed , study of both roots was performed. The right root was responding to 0.02 mA, but the left was responding to 0.35 mA.

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Routine closure of the wound.

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Smooth postoperative recovery, with full recovery of the power of both feet.


Comments

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Lumbar canal stenosis is a progressive disease and the sooner the better the outcome.

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Considering that the left L5 root was badly compressed, studying it with its counterpart, showed mild difference between the 2 nerves. But the functional status of the nerve was acceptable after decompression, for what prompt postoperative recovery was anticipated.


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