History :
28 year old moderately obese lady came to Lower Back Pain Specialist in Pune Dr. Sangram Rajale had severe of low back pain since 4 days with right lower limb radicular pain since 2 months. She was unable to walk without help of someone since last 4 days. She also had tingling in left and right leg since past 4 months. She complained of increased back pain on getting up and sitting down in bed turning. She was unable to sleep because of the pain.
Radiological Investigations :
MRI OF LUMBOSACRAL SPINE
Her MRI was noted by Top Spine Pain Clinic in Pune Dr. Sangram Rajale
L5/S1 Level:
Mild disc bulge: This means there is a slight protrusion of the intervertebral disc at the L5/S1 level, which is the lowest lumbar vertebrae and the first sacral vertebrae.
Right paracentral disc protrusion and extrusion: This indicates that part of the disc material has pushed out to the right side, beyond the normal confines of the disc space. Extrusion means that the disc material has actually ruptured through the outer layer (annulus fibrosus) of the disc.
Compression over ventral thecal sac: The protruding and extruded disc material is pressing on the ventral (front) side of the thecal sac, which contains cerebrospinal fluid and the spinal cord.
Significant thecal sac stenosis: Stenosis refers to narrowing. In this case, there is narrowing of the space around the thecal sac due to the disc protrusion and extrusion.
Mild encroachment into bilateral lateral recess neural foramina: The disc material is encroaching (pressing) into the openings (neural foramina) through which nerve roots exit the spinal canal on both sides.
Compressing the right traversing nerve root: The right nerve root that exits the spinal canal at this level is being compressed (pressed upon) by the disc material.
Operation :
On October 20, 2023, surgery was done on the lower back (L5-S1 area) using a microscope to help. This surgery relieved pressure on the nerves and stabilized the spine. The patient was asleep with general anesthesia. Slip Disc Surgery Specialist in Pune Dr. Sangram Rajale performed the surgery, and Jesco implants were used.
Condition On Discharge :
Patient stable in the postoperative course and was shifted to her room by Spine Surgery Specialist in Pune Dr. Sangram Rajale
She had complete pain relief immediately after the surgery
she had no back pain or leg pain.
She was made to work in the word on day 2 of surgery climb stairs on day 3 of surgery 3 of the surgery.
On day 15 of the surgery we called her for suture removal she had completely recovered.
she was an independent Walker did not need any support from anybody to do all her routine activities by 2 months of the surgery she had started her work again without any discomfort.
Q and A :
Obesity is associated with higher rates of surgical complications such as wound infections, blood clots, and pulmonary complications.
The presence of excess fat tissue can make it more difficult for the surgeon to access the surgical site and visualize the anatomy clearly, potentially leading to longer operating times and increased risk of surgical errors.
Obese individuals often have impaired wound healing due to reduced blood flow to the surgical site and increased tension on the incision site caused by excess adipose tissue.
Obese patients may have a higher risk of intraoperative and postoperative bleeding due to the increased vascularity of adipose tissue and the difficulty in achieving adequate hemostasis.
Anesthesia management can be more challenging in obese patients due to difficulties in airway management, increased risk of respiratory complications, and altered pharmacokinetics of anesthetic drugs.
Obese patients undergoing lumbar spine surgery may experience higher rates of postoperative complications such as wound infections, deep vein thrombosis, pulmonary embolism, and neurological deficits.
Obesity can result in limited mobility and decreased functional outcomes following surgery, which may impact rehabilitation and recovery.
Obese patients often require a longer hospital stay compared to non- obese patients due to increased postoperative monitoring and management of complications.