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16-FEBRUARY-2009  MARWAN ALI BANAT  55 YEARS  SEVERE LUMBAR CANAL STENOSIS WITH OLD POLIO LEFT LOWER LIMB.

Anamnesis:

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The patient came to the clinic 05-May-2008 complaining of right hip pain with right sciatica and numbness of the toes of the right foot for one year. The patient has polio since childhood, with severe paralysis of the proximal muscles left lower limb.

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MRI lumbar spine performed 13-April-2008 showed lumbar canal stenosis L3-4 and L4-5.

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On examination: the patient has difficult walking with scoliotic stance with power right quadriceps 3/5 and left 0/5. Abduction of the knees right 2/5 and left 0/5. Adduction of the knees right 2/5 and left 0/5. SLRS was 5 degrees with pain in the right and zero in the left due to polio. Babinski was positive both sides. The left foot was in flexor deformity  with weak both feet 3/5 in planter and dorsiflexion.

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MRI of the brain, dorsal and lumbar spine done 31-May-2008 showed only the stenosis of the above mentioned levels. The patient was advised to undergo surgery, but he escaped.

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The patient then came 15-February-2009 with deterioration the last month with new MRI of the lumbar spine performed 12-February-2009 showing the same stenosis with the same clinical picture.

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Decompressive laminectomy of L4 and partial of L3 and L5 was performed. Foraminotomy of both L4 and L5 roots was achieved. The epidural fat was absent at the compressed levels and the ligamentum flavum was adherent to the dura at L4-5 level, for what sharp dissection was used to avoid tear of the transparent dura.

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Smooth postoperative recovery with normalization of the power of both feet..

Comments

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Lumbar canal stenosis is a progressive disease and surgical intervention is better to be performed as soon as possible, especially when the patient has polio in one leg.

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For many years in the usual practice, drilling of the bony compressing elements before reaching the ligamentum flavum is very advantageous, since it bring surgical trauma to zero.

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