|
The patient came to the clinic 02-November-2006 in
wheelchair complaining
of LBP with numbness of the legs for 10 months and numb both
hands for 3 months. The condition is deteriorating with disturbance
of micturition for 3 months. MRI of the cervical spine
performed 25.February-2006 showing huge disc C3-4 with malacia
of the spinal cord at that level. On examination: the patient has
weak both upper limbs, more the hands 3/5 with hypalgesia palmar
side of both hands. He has hypalgesia below the right L1 and left
Th10 with dense analgesia both lower limbs. He has paraparesis
-plegia of both lower limbs more the left. The patient was sent to
perform MRI of the cervical and dorsal spine, which were done
showing regression of the PCD C3-4 and severe dorsal canal stenosis
D10-11, D11-12 and D12-L1 with malacia of the spinal cord at D11-12.
Decompressive laminectomy D11-12 and partial of D10 and L1 was
performed. Drilling was used to avoid surgical trauma during
decompression. There was no epidural fat all over and the dura was
very thin and transparent. Inspection of D11-12 disc revealed that
it is old and calcified and it was decided not violate it.
Smooth postoperative recovery.
Comments:
1. Dorsal canal stenosis is a rare condition and as in this
case he was treated for MS or amyotrophic lateral sclerosis.
2. Drilling help minimize surgical trauma. The lamina were
drilled so that they became paper-like and they crust by pressure
from inside and the ligamenta flava bulged out without using
Smith-Kerrison rongours. |
