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26-NOVEMBER-2008  MARYAM AHMAD AQEL  65 YEARS  DE NOVO PROGRESSING LUMBAR CANAL STENOSIS L1-2 WITH OLD PLD L1-2.

Anamnesis:

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The patient came to the clinic 17-November-2008 complaining of flail both feet for three months with right hip pain and unable to walk only with walker. The patient was operated by me 03-July-2003 for lumbar canal stenosis at L2-3, l3-4 and l4-5.

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On examination: the patient  has SLRS right side 80 degrees with pain. She had weak both quadriceps muscles 4/5 and bilateral drop feet with weak planterflexion right 2/5 and left 0/5 with abduction both knees 3/5.

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MRI lumbar spine performed 26-October-2008 showing lumbar canal stenosis above the previous surgery at L1-2 with extruded disc.

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The patient was sent for another MRI of the lumbar and dorsal spine with myelography, which confirmed the presence of the lumbar canal stenosis at L1-2 and the presence of an old calcified disc at the same level.

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Decompressive laminectomy of D12 and L1 was performed. There was no epidural fat at these levels. The spinal cord became lax with transparent dural sheet through which the spinal cord can be seen.

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Inspection of the disc of L1-2 and the annulus fibrosis revealed that it is better not to violate the disc space.

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Smooth recovery with some improvement of the right foot power.


Comments

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The patient has severe osteoporosis despite the fact that she is under aggressive antiporosis treatment. This pathology is the triggering factor for lumbar canal stenosis combined with the anatomical variation.

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The extruded disc was the triggering point for clinical manifestations, but it is hard and small in size with shallow disc space.

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Laminectomy of D12 was performed to prevent possible future progression of stenosis at the upper level.

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