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27-FEBRUARY-2010  HUDA ABDEL-AZZIZ ALIAN  63 YEARS  SEVERE LUMBAR CANAL STENOSIS L3-4 AND L4-5.

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

Anamnesis

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The patient came to the clinic 09-December-2009 complaining of LBP for 35 years of intermittent course. Two months ago felt down, after what exacerbation of LBP and bilateral leg numbness. She is incontinent for urine and defecation for one month. She has intermittent claudication and could walk less than 50 meters.

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MRI of the lumbar spine performed 26-February-2010 showing severe lumbar canal stenosis L3-4 and L4-5 with old spondylolisthesis L4-5 and fused L4-5.

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On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 80 degrees with pain both sides. Hypalgesia both feet due to diabetic neuropathy up to the ankles. There is weak dorsiflexion 4/5 of both feet.

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Decompressive laminectomy L4 and partial of L3 and L5 was performed and foraminotomy of both L5 roots was achieved. Check for instability confirmed slight overmobility at L3-4 level, but L4-5 was stable due to fused L4-5 disc.

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Routine closure of the wound.

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Smooth postoperative recovery, and the power of both feet improved.


Comments

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The disc space of L4-5 was very shallow, for what the spondylolisthesis was an old one and there is no overmobility at this segment.

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The surgery was indicated for L4-5 and decompression of L3-4 was precautionary to prevent near future escalation of the stenosis. The overmobility was at L3-4 level, for what it was ignored.


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