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Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

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22-NOVEMBER-2008  MUHAMED RASHAD ZAYDAN  75 YEARS  SEVERE LUMBAR CANAL STENOSIS L2-3, L3-4, L4-5 AND L5-S1.

Anamnesis:

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The patient came to the clinic 22-October-2008 complaining of LBP for 7 years with right sciatica for one month with numbness all toes right foot. He could not walk more than 150 meters due to intermittent claudication with ataxic gait.

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MRI lumbar spine performed 19-April-2008 showed lumbar canal stenosis at L4-5.

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On examination: the patient is limping. There is right sided hypalgesia below D11 level. Weak dorsiflexion right foot 3/5 and left foot 4/5.

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The patient was sent for investigation: MRI of the brain, cervical, dorsal and lumbar spine and bone density scan.

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Investigations done 06-November-2008 which confirmed the presence of spinal cord malacia behind D2-3 without compression. There is severe stenosis at L2-3, L3-4, L4-5 and L5-S1 levels.

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Decompressive laminectomy of L3-4-5 and partial of L2 and upper sacrum was achieved. Foraminotomy of L3-4-5 and S1 both sides was done with more attention to the right side. The patient during surgery have bleeding tendency, which made the surgery more difficult to perform, using during that a lot of bipolar coagulation monopolar dissection and waxing.

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Smooth recovery with prompt improvement of the power of both feet.


Comments

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The patient had relatively massive bleeding during surgery, which required to pay special attention to all steps of surgery, using during that all available techniques for hemostasis. His Hb was more than 13 mg/dL, for what it was not needed to transfuse blood for him.

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The presence of malacia of the dorsal spinal cord could play a part in his clinical picture, but the stenosis is a progressive disease, which needs intervention.

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