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The patient came 16-August-2006 complaining of bilateral sciatica
for 13 years with intermittent claudication with signs of bilateral
CTS. The claudication is progressing the year and he cannot walk
more than 200 meters. MRI lumbar spine done 28-May-2005 showing
lumbar canal stenosis L3-4 and L4-5. MRI cervical spine performed
06-August-2006 showing PCD C4-5 and C5-6.
On examination: shuffling gait for 1 year with weak dorsi and
planterflexion both feet. with absent AJ both sides. The sensation
and power of both upper limbs are normal.
The patient was sent to perform MRI lumbar spine with MR
myelography, which confirmed the progression of stenosis.
Decompressive laminectomy of L3 and 4 and partial of L2 and
L5 was perfumed. All the compressive elements were removed and
foraminotomy of both L4 and L5 roots both sides was done. The
dura was very thin and lacking of epidural fat. Routine closure.
Prompt postoperative recovery.
Comments: 1. Decompression
in LCS must include all the neural structures including the roots.
It must also include the levels, which is expected to escalate, as
the L2-3 in this case to avoid possible near future surgery. |
