History :
This patient was a 66 years old gentleman who came with complaints of Low Back Pain since 10 years which aggravated since 2 years. His pain use to increases on getting up from sitting position, while sitting down, while bending forward and walking (this symptom indicates that there is some abnormal movement happening in his spine wherein, when the patient tries to sit down, get up, move around the movements happening in his spine are not as they are designed to be, hence it cause pain). He was also unable to walk for more than 5 min without taking a break.(This symptom in medical terms is called as claudication wherein the patient is unable to walk without standing or sitting for a long duration) We also noted that his footwear used to slip from foot without him realizing it since 6 months.
He was walking with a forward Stooped that is he use to bend forward and walk.
1.When asked to walk on Heel and Toe he was unable to because of reduced power.
2.When asked to bend forward and touch his toes, he was unable to do it because of pain.
3.When we checked the power in her legs her ankle movement and her toe movements work week in both her legs. This weakness indicated that the compression in his spin was so severe that it had caused motor deficit that is power loss on taking detailed history he further told that the power was reducing gradually over a couple of years and it was not a sudden loss.
MRI :
The patient has a condition called grade 1 anterolisthesis, which means that one of the spinal bones (L3) has slipped forward over the one below it (L4), but there’s no breakage in the bone.< There are also issues with the discs between certain spinal bones: at the levels L2-3, L3-4, and L4-5, there’s degeneration (wear and tear) of the discs along with bulging of these discs. This is accompanied by the growth of bone in the spine’s joints (facet joints) and thickening of a ligament called the ligamentum flavum. These changes are causing a significant narrowing of the spinal canal (where the spinal cord is located), which is known as severe canal stenosis. Additionally, there’s also a narrowing of the spaces on the sides of the spinal canal called lateral recesses and the openings through which nerves exit the spine known as neural foramina. This narrowing is putting pressure on the nerves that pass through these spaces, affecting both sides.
Operation :
On August 11, 2022, the patient had a surgical procedure called “L2-S1 laminectomy with posterolateral fusion fixation decompression.” This surgery involved several steps: Laminectomy: This means that parts of the vertebrae (the bones in the spine) from levels L2 to S1 were removed to relieve pressure on the spinal cord and nerves. Posterolateral Fusion Fixation: This refers to a procedure where the surgeon stabilizes the spine by fusing (joining together) certain spinal segments using special hardware like screws, rods, or plates placed on the back and sides of the spine. Decompression: This term means the surgery also involved removing anything that was compressing or pressing on the spinal cord or nerves, such as bone spurs or herniated discs. The entire surgery was performed while the patient was under general anesthesia.
OPERATING SURGEON- DR. Sangram Rajale
Condition On Discharge :
Patient stable after the surgery and was shifted to the ward. On post operative day one we made him sit in bed. On the second day of surgery we made him walk in the ward he had some discomfort and due to the pre existing power loss he was unable to walk straight even after surgery. On day 3 and day 4 with help of the physiotherapist we gave him some braces and made him walk he was very comfortable and was happily discharged. On follow up after one month he was completely out of braces walking independently climbing stairs and doing all his daily chores on his own. By the end of 3 months the patient was told to sit down on the floor bend forward and do all his routine activities.
Faq's :
Degenerative scoliosis is primarily caused by the natural aging process and degeneration of the spine’s discs and joints. Other contributing factors may include osteoporosis, spinal stenosis, or previous spine surgeries.
Symptoms of degenerative scoliosis can vary but may include back pain, stiffness, difficulty standing or walking for long periods, and in severe cases, nerve compression leading to numbness, weakness, or pain in the legs.
Diagnosis typically involves a physical examination, medical history review, and imaging tests such as X-rays, MRI, or CT scans to assess the curvature of the spine and identify any underlying issues.
Treatment options depend on the severity of symptoms and may include conservative approaches such as physical therapy, pain management, and bracing. In more severe cases, surgery may be recommended to correct the curvature and alleviate symptoms.
While degenerative scoliosis cannot always be prevented, maintaining a healthy lifestyle including regular exercise, proper posture, and avoiding activities that strain the spine may help reduce the risk of developing symptoms.
The prognosis varies depending on the severity of the curvature and how well it responds to treatment. With proper management, many individuals with degenerative scoliosis can effectively manage their symptoms and maintain a good quality of life. However, in some cases, symptoms may worsen over time and require ongoing care.