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30-OCTOBER-2008  UMAR MUHAMED AL-TURK  58 YEARS  LUMBAR CANAL STENOSIS D12-L3 WITH EXTRUDED DISC L2-3 CENTRAL MORE TO RIGHT.

Anamnesis:

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The patient came to the clinic 22-October-2008 complaining of numbness both feet for 2 years. !8 days ago, the patient after bending in the toilet, got LBP and left sciatica  with dyseasthesia lateral aspect left thigh. Later he progressed right sciatica with numbness all toes right foot.

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The patient was operated 28 years ago for PLD L4-5 by using grafts lateral to the spinous processii.  The patient was suspected to have renal failure  four months ago and was put in treatment with cortisone for three months and he was treated for diabetes mellitus. He was also under treatment for hypertension with Atakand and Zestril.

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On examination: the patient is limping with exaggerated scoliotic stance, bending forward  with SLRS 85 degrees in both sides with pain and drop right foot and weak planterflexion right foot 4/5. There is also weak dorsiflexion left foot 3/5 and knee abduction 4/5. Hypalgesia of right L5 and S1 territories. There is urgency and frequency for the last 4 days.

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MRI lumbar spine was performed 24-October-2008 showing severe lumbar stenosis starting from D12 down to L3 with central more to right extrusion of L2-3.

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The patient was admitted one day before surgery and monitoring ruled out the presence of diabetes mellitus  and he had profound hypotension due to suprarenal depression induced by cortisone. It was necessary to give him cortisone to elevate his blood pressure.

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Decompressive laminectomy of D12, L1, L2 and partial of L3 was done. The extruded disc of L2-3 was attacked from the right and removed and meticulous cleaning of the disc space was achieved from the left side. The epidural fat was absent at all exposed level.

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Smooth recovery with slight improvement of the power of the left foot. The drop right foot still the same but planterflexion improved.

Comments

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The patient has severe compression of the spinal cord at D12-L1 level with malacia. Recovery of this part will determine the whole outcome of the patient.

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The patient underwent fusion of L3-4-5 by using bony grafts parallel to the spinous processii 28 years ago.  The patient claim that he improved after such surgery, for what the old extrusion of L4-5 was not violated. This maneuver could be the cause of his recent escalation of the PLDs  at these high levels D12-L1 and L2-3, because the stress points migrated upward.

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The expected recurrence rate in this case is below the average, because the disc space height shallow.

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