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18-SEPTEMBER-2010 MUHAMED SAAD AWWAD BARBID 57
YEARS LUMBAR CANAL STENOSIS L4-5.
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to the clinic 13-September-2010 complaining of LBP
for 26 years. The patient progressed agonizing
bilateral sciatica the last 15 days more to the
left. The patient is a known diabetic.
MRI lumbar spine
performed 19-August-2010 showing lumbar canal
On examination: The
patient walking with bended position. He has
exaggerated scoliotic stance. SLRS
was 90 degrees in the left with pain and weak
dorsiflexion 4/5 both feet.
There is hypalgesia and numbness left L5 territory.
The patient was sent
for further investigations, which confirmed the
presence of posterior compression due to L4-5
ligamentum flavum hypertrophy. ESR was 31 mm/h.
The patient was
advised to keep in conservative treatment, but
he refused such suggestion, telling that he came
from YAR and it is difficult for him to come
back in case of deterioration.
of L4 and partial of L5 was performed, during
the first stage of the skeletonization the soft
tissues came with great force, confirming that
there was great pressure. Bilateral flavotomy of
L4-5 was achieved and foraminotomy of both L5
roots was done. There were signs of chronic
inflammatory changes involving the ligamentum
flavum and the epidural fat. Inspection of the
posterior wall of the L4-5 disc revealed no
extrusion. Check for instability denied any
presence for overmobility.
Routine closure of
the wound and smooth postoperative recovery with
improvement of the power of both feet and
disappearance of sciatica.
The presence of segmental
chronic hypertrophic ligamentitis of the
ligamentum flavum with exacerbation of the
inflammation, were the cause of the patient
problem. It is rare to operate such case. The
patient urged for surgery and he was with the
The lumbar canal stenosis is
a progressive disease and even if surges of
inflammation took place, surgery will stop the
escalation of such events.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .