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14-MAY-2008  HABUBAH IZZIDEEN SHEHADAH  74 YEARS  LCS L2-3, 3-4 AND L4-5 WITH FORAMINAL STENOSIS MORE THE LEFT L5 ROOT TRAJECTORY.

Anamnesis:

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The patient came to the clinic 19-April-2008 complaining of LBP with left sciatica for one week. She could walk only 100 meters.

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MRI performed 07-July-2007 showed lumbar canal stenosis at L3-4 and L4-5.

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On examination: the patient is limping with scoliotic stance. SLRS was 70 degrees with pain in the left side. There was weak dorsiflexion both feet 4/5 and planterflexion right foot -4/5 and left foot 4/5 with hypalgesia left L5 territory.

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MRI lumbar spine with MRMyelography done 19-April-2008 showed LCS at L2-3, 3-4 and L4-5 with left L5 root foraminal occlusion.

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The patient is a known hypertensive with cardiomyopathy, for what, she was sent for cardiac consultation prior to admission.

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Decompressive laminectomy L3-4 and partial of L2 and L5. Foraminotomy of all running roots was achieved. Special attention was paid to the left L5 root. It was compressed by the ligamentous structures of the left facet joint, fulfilling all the foramen.

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Routine closure of the wound with smooth postoperative recovery.

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Considerable improvement of the power of both feet.

Comments

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Lumbar canal stenosis is a progressive disease and the surgical intervention is the only solution for the progressive one. Wide decompression is recommended to eliminate all the compressive elements. Otherwise the patient will show clinical manifestations of the untreated part. Laminotomies are of no help in these cases and practice confirm these observations.

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