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History :
A 60-year-old gentleman presented to the hospital with complaints of left lower limb pain persisting for two years, which worsened over the past six months. He has history of lower back pain and reports an exacerbation of pain while walking and sitting. Additionally, he notes neuroclaudication lasting for approximately 15 minutes, as well as urinary dribbling for the past two months and paresthesia in the left lower limb. He is a known case of left-sided foot drop for three years and has no history of bowel complaints or known comorbidities.
On examination, he exhibits a high-stepping gait. His lumbar spine demonstrates full and free flexion but painful extension.
Before surgery, the patient’s left side is weaker compared to the right:
Left hip and knee strength are 4+/5 compared to 5/5 on the right.
Left ankle dorsiflexion strength is 0/5, while it’s 5/5 on the right.
Specific muscles in the left foot have no strength (0/5) compared to full strength (5/5) on the right.
The slouch test is positive on both sides.
Sensory perception is intact overall, but decreased over specific dermatomes (L4, L5, S1) on the left side.
MRI- WHOLE SPINE (1/3/23) :
Anterior wedge compression of L2 vertebra with mild acute kyphotic deformity: This was contribute to the left lower limb pain and neuroclaudication experienced by the patient, especially when it’s impinging on spinal nerves.
Diffuse annular disc bulge at L2-L3 causing moderate right neural foraminal narrowing: This finding was associated with the increased pain while walking and sitting, as well as the urinary dribbling and paresthesia in the left lower limb, especially if it’s affecting nerve function in the lumbar region.
Overall, the medical findings aligned with the clinical history, suggesting potential sources of the patient’s symptoms, such as nerve compression due to disc bulge and vertebral compression.
Operation :
L1-L2 Decompression: This involves removing tissue or bone structures that were be compressing spinal nerves at the L1-L2 level.
Pedicle Subtraction Osteotomy (PSO) at L2: This is a surgical technique used to correct spinal deformities, such as kyphosis, by removing part of the vertebral body (in this case, L2) and realigning the spine.
D12 to L4 Pedicle Fixation: Pedicle fixation involves stabilizing the spine using screws and rods attached to the vertebrae
This surgery aimed to address the structural issues in the spine, such as compression, deformity, and instability, to relieve symptoms and improve the patient’s spinal alignment and function.
The surgery was performed under general anesthesia by Dr. Sangram Rajale, and JAYON implants were used for the fixation.
Condition On Discharge :
At the 6-month mark post-surgery, the patient showed remarkable improvements:
Enhanced Mobility: Previously struggling with walking comfortably due to lower limb pain, the patient now moves with ease, indicating successful pain alleviation and improved mobility.
Restored Urinary Control: Urinary dribbling, a pre-surgery symptom, stopped completely, resulting in resolution of urinary dysfunction.
Significant Pain Reduction: The patient experienced substantial pain relief, due to the surgical interventions addressing nerve compression and spinal instability.
Satisfaction: Expressing contentment with the surgery, the patient’s positive feedback underscores the overall success in meeting expectations and enhancing well-being.