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07-JANUARY-2010 AFIFAH ALI MUQBEL LUMBAR CANAL STENOSIS WITH RIGHT
SIDED EXTRUSION AT L4-5 LEVEL.
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Anamnesis:
The patient
came to the clinic 09-December-2009 complaining
of LBP for 2 months with right sciatica and
numbness left foot. MRI performed
28-September-2009 showing severe lumbar canal
stenosis L2-3, L3-4 and L4-5.
On examination: the patient
had exaggerated scoliotic stance with weak
dorsiflexion right foot 4/5 and left foot -4/5.
MRI lumbar spine repeated
04-January-2010 showing very severe lumbar canal
stenosis L4-5 with right extrusion at this level
with lesser degree of stenosis at upper 2
levels.
Decompressive laminectomy of
L4 and partial of L5 with foraminotomy of right
L5 root. The dura was transparent due to severe
compression and the epidural fat was absent.
The extruded disc was movable, for what right
sided cleaning of L4-5 was achieved lateral to
the axilla. A dural tear was noticed in the
lateral wall of the axilla without CSF leak. It
was repaired with nylon 6 zero so as to avoid
possible postoperative CSF leak. Putting the
head up and using Valsalva maneuver ruled out
CSF leak.
Routine closure of the wound
and smooth postoperative course and improvement
of the power of the feet.
Comments
The patient has many
morphological problems, the selection of the
most prominent and responsible for the patient
complain must be targeted and corrected
accordingly.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
