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The patient came to the clinic 18-March-2006 complaining
of left sciatica for 45 days with positive cough sign. The patient
is a known diabetic and cath cardiac vessels done
17-August-2005. The patient have urgency and frequency the last 3
months. On examination that time, the patient had hypalgesia left
lower limb above the knee with weak dorsi and planterflexion both
feet. MRI performed 28-October-2005 showed extruded disc L1-2 with
bulge L4-5 and L5-S1. The patient was sent for another MRI and
given medication. The patient came 01-May-2006 with new MRI
performed 30April-2006 demonstrating severe lumbar canal stenosis
from L1-2 down to L4-5. The patient condition continued to
deteriorate and intermittent claudication with inability to walk
more than 100 meters.
Decompressive laminectomy of L2-3-4 and partial of L1 and L5 was
performed and foraminotomy for L2-3-4-5 roots was performed from
both sides. Smooth postoperative recovery.
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. he clinical course of the patient was changing over time
and the surgical decisions also. At the beginning, he was in
need for discectomy of L1-2, but later he required surgery for
lumbar canal stenosis. |
