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Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

 

 

DR. ZAKARIYA MUHAMED AL-NATSHEH  56 YEARS  SEVERE LCS L2-3, L3-4 AND L4-5 WITH BILATERAL LATERAL RECESS SYNDROME.

The patient came to the clinic 23-March-2005  complaining of LBP for 10 years with intermittent bilateral sciatica for 6 months, more the right. He could walk 500 meter. He is blind in the left eye since childhood. MRI of the lumbar spine performed 06-March-2005 showed mild stenosis at L2-3, L3-4 and D11-12.  On examination: he had no neurologic deficit and he was advised to be treated conservatively. The patient  then came 29-October-2006 complaining of exacerbation of LBP with bilateral sciatica the last 4 months  and he could not walk more than 100 meters with intermittent claudication. He had weak dorsi and planterflexion right foot with hypalgesia of right S1 root territory.

MRI of the lumbar spine with MR Myelography were performed 13-November-2006  showing severe LCS L2-3. L3-4 and L4-5  with bilateral lateral recess syndrome.

Decompressive laminectomy of L3,4 and partial of L2 and L5 was performed and bilateral foraminotomy for L3, L4, L5 roots was achieved. It was noted that the patient had transverse fracture of the medial facets of L2 both sides, but the construct was stable. The loose fragments were removed.

Comments:

1.  LCS is a progressive disease and when the patient start to have progressive neurologic deterioration, surgery must be performed to prevent further deterioration.

2.  The cause of the transverse fracture, which seems to be a new one, could be due to vigorous physiotherapy. Check for instability must be performed to insure that fixation is not required, as in this case.

3.  Drilling help during the surgery and lower the surgical trauma to the already compressed neural tissues.

 

 


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved