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The patient came 27-July-2003 complaining of LBP with bilateral
sciatica with numbness of the right foot. She could not walk more
than 100 meters. MRI lumbar spine performed 28-November-1995 showed
LCS L2-3, L3-4 with spondylolisthesis L4-5 and L5-S1. On examination
at that time, she had weak dorsi and planterflexion both feet. MRI
of the lumbar spine with dynamic studies were requested and given
medications and MRI showed spondylolisthesis L3-4 and L4-5 with
isthmolysis. The patient was advised to undergo surgery for
discectomy L3-4 and L4-5 with transpedicular fixation. The patient
performed surgery elsewhere. The patient came 29-August-2006
complaining of neck pain shooting to the left shoulder for one year
with cephalic pain. She had numbness of the left ulnar distribution
with Hoffmann positive both sides with weak grip, extension left
hand and left triceps muscle. She had hypalgesia of the left ulnar
distribution with weak dorsiflexion right foot and hypalgesia right
L5 territory. The patient was sent for MRI of the cervical spine,
and it was done 30-August-2006 and showed PCD C3-4 and C5-6 with
inverted curvature of the cervical spine with malacia of the spinal
cord at these levels.
Considering that the malacia is due to dynamic repetitive injury
of the spinal cord from the underlying causes, it was decided to
undergo surgery.
Discectomy of C3-4 and C5-6 was performed and using Stryker three
level miniplate with screws, fusion of the cervical spine between
C3-6 was achieved. Correction of the inverted curvature was
noted after fusion. Routine closure and postoperative recovery.
Comments:
1. The previous case performed yesterday, has a lot of similarities,
but the plan of surgery was different. That was because the
patient's malalignment of the cervical spine played a major role in
repetitive microtrauma to the spinal cord. The aim of surgery
was to reduce the alignment to push away the bodies of C4 and
C5 from the spinal cord, preventing by this means the repetitive
trauma. |
