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The patient came 31-July-2003 complaining of LBP for 12 years
with bilateral sciatica for 1 year more to the left. She could not walk more
than 100 meters with intermittent claudication. She is a known
hypertensive for 2 years. ESR performed 19-December-2005 was 50
mm/h. On examination: the left AJ is absent with weak
dorsiflexion both feet and planterflexion left foot. MRI lumbar
spine with MR myelography was requested and performed 01-August-2006
showing bulge L4-5 with old collapse of L3-4 disc space, resulting
in LCS L2-3, L3-4 and L4-5.
Decompressive laminectomy L3-4 and partial of L5 was performed
and foraminotomy for L4 and L5 roots both sides was done. There was
a severe lateral recess syndrome left side, which was dealt
accordingly. The left L4 root was severely compressed and the
epidural fat near that area was rubbery in consistency, denoting
that some inflammatory process took place in the past. Inspection of
the disc spaces were negative for presence of extruded fragments.
Routine closure of the wound with smooth postoperative recovery.
Comments:
1. LCS is a pathological entity, that could be silent, until
some pathologic process provoke it, such in this case. Considering
the relative young age of patient, the precipitating factor could be
a hidden inflammatory process, which triggered the escalation of the
clinical picture. |
