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25-AUGUST-2008  HAFITHA MUNEEB SHADEED  70 YEARS LUMBAR CANAL STENOSIS WITH LEFT EXTRUDED DISC AT L4-5.

Anamnesis:

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The patient came to the clinic 18-August-2008 complaining of LBP for 10 years with exacerbation the last 2months and right sciatica. She was walking with help of two persons with bended posture.

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The patient is a known diabetic insulin-dependent for 20 years with arterial hypertension for 10 years  and hypothyroid in L-thyroxin 100 microgram daily.

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MRI performed 09-August-2008 showed lumbar canal stenosis with left extruded disc L4-5.

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On examination: the patient is unable to walk with scoliotic stance with weak dorsiflexion  both feet 3/4 and shooting left sciatica.

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Decompressive Laminectomy L4 and partial of L5 was done. Bilateral foraminotomy of both L5 roots was performed and the ligamentum flavum was severely adherent to the dura, that some parts were left in the posterior aspect after removing the lateral portions. The extruded disc was removed from under the left L5 root lateral to the axilla in several pieces. Meticulous cleaning of the L4-5 disc space was achieved from the left.

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Routine closure of the wound and smooth postoperative recovery.

Comments

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The patient has old stable spondylolisthesis L4-5 with multiple bony deformities at the spinous process and lateral facet joints, the it was necessary to use the image-intensifier to localize the L4-5 level, which was in parallel to the adherent ligamentum flavum.

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The disc space was not shallow, which could give the estimated recurrence around 7%

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Considering that the patient has diabetes mellitus, monopolar dissection was avoided to decrease the thermal injury to the soft tissues and decrease the expected rate of postoperative infection. In this case we usually use the No11 blade.

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