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The patient came 13-August-2006 complaining of LBP for 2 years
with bilateral sciatica. He is using crutches after surgery for PLD
1 year ago and 8 months ago for redo. MRI done
25-November-2005 showing status after discectomy of L4-5 and L5-S1.
On examination: SLRS was 80 degrees both sides with absent knee and
Achill's reflexes with Babinski both sides with weak right
quadriceps 4/5 and both knees abduction and adduction 4/5 and
dorsi and planterflexion both feet 4/5 both with hypalgesia
right lower limb up to the knee level.
Considering that the discrepancy of the neural involvement, MRI
of the dorsal and lumbar spine were requested and done. At the
previous operated site there are a lot of adhesions, but no
recurrence was noted. At the level of D10-11 there is dorsal canal
stenosis with malacia of the spinal cord at that level.
Using image intensifier, decompressive laminectomy of D10 and D11
was performed with drilling of hypertrophied facets, which were
kissing each other with absent epidural fat was noted.
Complete decompression was done and during the last steps of
decompression partial avulsion of the left Th10 accidentally took
place by the Smith-Kerrison tip with subsequent dural tear, which
was repaired with nylon 6 zero. Check for CSF leak was negative.
Routine closure of the wound.
Prompt postoperative recovery and immediate normalization of the
power of both lower limbs.
Comments: 1. Dorsal canal
stenosis is rare in occurrence, but it strongly resemble the process
taking place in the lumbar area. There is difference in that, there
is no bony compression as in the lumbar area, but the hypertrophied
ossified facets are the main cause for stenosis. The PLL play no
role in this area as in the cervical spine. |
