|
The patient came to the clinic 15-June-1999 complaining of
intermittent claudication for 5 years with progressing course.
On examination at that time he had no motor or sensory deficit. MRI
with MR Myelography of the lumbar spine requested and the patient
disappeared. The patient then came 11-November-2001 with numbness
of the left lower limb after bending with sciatica. MRI done
10-November-2001 showed extruded disc L3-4 with segmental stenosis
at L3-4 and L4-5. He was limping with SLRS 45 degrees in the
left with hypalgesia of the entire anterior thigh and foreleg
with weak adductors and abductors of the left knee and quadriceps
femoris left leg. The patient was advised to undergo surgery but he
disappeared another time.
The patient came 06-May-2006 with intermittent claudication with
dripping of urine for 3 months with inability to walk even 10 meters
with weak planterflexion both feet more the left. MRI of the lumbar
spine requested and performed which showed LCS L3-4 and L4-5 with
the previous extrusion shrunken, but the left lateral recess
syndrome took over.
The patient was operated and decompressive laminectomy L4 and
partial of L3 and L5 was done. Foraminotomy of the left L4 root was
performed. Exploration of the L3-4 disc showed that, it is not
necessary to violate it. Routine closure .
Prompt postoperative recovery.
Comments:
1. The patient over the time can change the clinical picture and
the strategy for surgery accordingly.
2. Time will show, how the delay, in surgery taking decision, could
affect the level of recovery. |
