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The patient came to the clinic 08-May-2006 complaining of LBP for 15
years with bilateral sciatica, more the right in the last 2 years
with inability to walk more than 40 meters with intermittent
claudication. The patient is a known diabetic and hypertensive
for 15 years. The patient underwent resection of the right kidney 50
years ago. On examination: SLRS was 70 degrees in the left with
scoliotic stance and weak dorsiflexion both feet and
planterflexion right foot. MRI requested and done 11-May-2006 which
showed LCS at L3-4, L4-5 and L5-S1 more severe at L4-5.
Complete laminectomy of L4 and 5 was performed with partial lower
half of L3. Foraminotomy of both L5 roots was performed. Inspection
of the disci was negative for presence of extrusion.
Smooth postoperative recovery.
Comments: 1. Drilling help
minimize surgical trauma to the already compressed neural elements.
It has great advantage, that eliminating the bony elements before
the ligamentous structures, make the later protrude and reduce
pressure before reaching them. After regaining relaxation, using the
Smith-Kerrison with small jaws drive the surgical trauma to zero
level. 2. Foraminotomy is mandatory in all cases of LCS, because
LCS and lateral recess syndrome come together all the time, and both problems must be resolved
during surgery. |
