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25-SEPTEMBER-2010  IZDIHAR RASHEED AL-MASRY  75 YEARS  SEVERE LUMBAR CANAL STENOSIS L4-5 WITH MILD SPONDYLOLISTHESIS.

Anamnesis

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The patient came to the clinic 16-August-2010 complaining of bilateral sciatica for 3 months and LBP for one week with numbness both feet. The patient underwent open heart bypass 13 years ago and known to be hypertensive for 10 years. She has bronchial asthma for 15 years, hyperlipidemia for 10 years  and underwent discectomy  lumbar area 28 years ago.

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On examination: The patient swaying when walking and has scoliotic stance. Romberg was stable. Tinnitus right ear for 4 years. She has weak grip and extensors of the right hand and weak triceps right upper limb. The right foot dorsiflexion -4/5 and planterflexion 4/5.

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MRI of the brain done 17-August-2010 showing scattered infarctions both cerebral hemispheres, more in the left pulvinar and right anterior thalamic area. MRI cervical area showing cervical stenosis C4-5. 5-6 and 6-7 with retrolisthesis at C4-5. The lumbar area showed severe stenosis L4-5 with elements of spondylolisthesis and bulge L3-4 and L5-S1. The uric acid was 7.8  and Ferretin level 18.

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The patient was sent for cardio and pulmonary consultation and was reevaluated accordingly.

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Skeletonization of L4 and upper part of the sacrum. The spinous process of L4 is stable not movable. Decompressive laminectomy of L4 and the remnants of L5. Foraminotomy of both L5 roots.  Bilateral flavotomy of L3-4. The epidural fat was absent due to severe compression. The right L5 root was free of adhesions and became free. The left L5 root was involved with adhesions from the previous surgery and bony decompression was achieved. Check for instability was performed at all stages of the surgery: The facets of L4-5 were fused by the old degenerative changes. The disc of L4-5 was inspected. It was decided not to violate it.

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Routine closure of the wound and smooth postoperative recovery and the power of the right foot became normal.


Comments

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Lumbar canal stenosis is a progressive disease and the sooner the decompression, the better the outcome.

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The patient have mild degree of spondylolisthesis. In the plan of surgery transpedicular screw fixation was considered, but it was not necessary, because there was no segmental overmobility.

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The patient was lucky, that she had osteoporotic bone and she did not need fixation. In case of fixation in such a case, negative drawbacks could take place in the postoperative period.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

 


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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 .

 

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