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26-JUNE-2008  ABDEL-RAHMAN SBETAN SHALABI  69 YEARS  LCS L3-4, L4-5 WITH ANEURYSM OF THE AORTA BELOW THE RENAL ARTERIES.

Anamnesis:

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The patient came to the Emergency of Al-Shmaisani hospital 23-June-2008 and then to the clinic 24-June-2008 with LBP and left sciatica for 3 years with progressive intermittent claudication. The patient the last months cannot walk more than 100 meter.

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MRI of the lumbar spine done 32-June-2008 showing lumbar canal stenosis L4-5 with lesser degree of L3-4.

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On examination: the patient is complaining of tingling sensation of the left loin and both lower limbs. There is weak dorsiflexion both feet 4/5 and planterflexion left foot 4/5. The patient during workup showed a giant wide based aneurysm of the aorta below the renal arteries and without Leriche syndrome. There is stenosis of the left renal artery and the patient underwent stinting for coronary arteries several years ago.

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Considering that the patient had aneurysm of the aorta, special attention was paid for his positioning to prevent compression of the abdominal cavity and femoral arteries.

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Laminectomy of L4 and partial of L3 and L5 was performed. Foraminotomy of both L5 roots was performed. It was noticeable, that the patient had soft tissue compressing elements arising from the left L4-5 facet joint, which was subsequently decompressed. The presenting epidural remnants were preserved, but it was missing at 2 levels due to the severe compression. Routine closure of the wound.

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Smooth postoperative recovery and the power of both lower limbs improved.

Comments

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The patient had intermittent claudication and the two major causative factors are Leriche syndrome and lumbar canal stenosis. The patient had aneurysm of the aorta below the renal arteries, but the flow was patent. The patient had severe lumbar canal stenosis, which was the cause of his complains in this case.

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The presence of such aneurysm requires special attention to prevent rupture during surgery. The positioning with high intra-abdominal pressure could lead to rupture and all measures must be done to prevent such as these triggering factors.

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