History :
A 46-year-old woman came to Spine Surgery Specialist in Pune Dr. Sangram Rajale because she had been having lower back pain that spreads down her right leg for about six months. The leg pain is worse than the back pain. Her pain has been getting worse over time. She mentioned that she can only walk for about five minutes before needing to sit down. Also, she noticed that she’s been walking with a tilt recently.
Interestingly, Spine Pain Treatment in Pune Dr. Sangram Rajale had previously performed spine surgery on her sister for a different spine issue. Seeing her sister recover well from the surgery made this lady believe that spine surgery is safe. Because of this, she decided to go ahead with the surgery for her own back and leg pain.
ON EXAMINATION OF LUMBO-SACRAL SPINE-
Top Spine Specialist in Pune Dr. Sangram Rajale noticed that she walked with a noticeable tilt to the left. Bending forward caused pain, but leaning back was fine. Her heel and toe walking were normal. Lifting her right leg during the Straight Leg Raise test caused pain, suggesting nerve issues in her right leg. This could have been related to her lower back pain and the pain radiating down her right leg that she had been experiencing.
Putting it all together, this person’s gait shows a tendency to lean to the left while walking. When they bend forward (flexion), it’s painful, but extending backward (extension) is normal. The Straight Leg Raise test was positive on the right side, suggesting possible nerve-related problems in the right leg.
MRI :
LUMBAR SPINE WITH WHOLE SPINE SCREENING(11/07/2023)
The MRI report described abnormalities in the spine, including fusion of the L5 vertebra to the sacrum, disc degeneration, central disc perforations, and narrowing of the spinal canal (stenosis) at the L2-3 and L3-4 levels. These findings can contribute to symptoms such as back pain, leg pain, and neurological issues, depending on the extent of compression on the spinal cord and nerves.
Disc degeneration and central disc perforation seen at L2-3 level with moderate canal stenosis:
- Disc degeneration: Refers to the wear and tear of the discs between the vertebrae. This can lead to reduced disc height and changes in the disc’s structure.
- Central disc perforation: Indicates that there is a tear or rupture in the center part of the disc at the L2-3 level.
- Moderate canal stenosis: Means that there is narrowing of the spinal canal at the L2-3 level. This narrowing can put pressure on the spinal cord and nerves passing through the canal.
Disc degeneration and central disc perforation seen at L3-4 level with severe canal stenosis:
- Disc degeneration: Similar to the L2-3 level, there is wear and tear of the disc at the L3-4 level.
- Central disc perforation:There is also a tear or rupture in the center part of the disc at the L3-4 level.
- Severe canal stenosis: Indicates a more significant narrowing of the spinal canal at the L3-4 level. This severe narrowing can lead to increased pressure on the spinal cord and nerves, potentially causing more symptoms.
Operation :
A surgical procedure that was performed on July 18, 2023, under general anesthesia by Best Spine Specialist in Pune Dr. Sangram Rajale
The reason for performing the L2-L4 foraminotomy and L3-L4 microdiscectomy was to address symptoms related to nerve compression or irritation in the lower back and legs. Conditions, herniated discs, spinal stenosis, or foraminal stenosis was causing these symptoms by putting pressure on the spinal nerves. The surgical procedures was aimed at relieving this pressure and improving the patient’s symptoms and overall function.
L2-L4 Foraminotomy:
This refers to a surgical procedure aimed at relieving pressure on nerves in the spinal canal. Specifically, it involves enlarging the neural foramen, which are openings through which nerves exit the spinal cord and travel to other parts of the body. By widening the foramen, pressure on the nerves can be reduced, alleviating symptoms such as pain, numbness, or weakness in the areas supplied by those nerves.
L3-L4 Microdiscectomy:
This is a surgical procedure commonly used to treat herniated or protruding discs in the lumbar spine (lower back). In a microdiscectomy, a small portion of the herniated disc material is removed, relieving pressure on the nearby spinal nerves. This can help reduce pain, numbness, and other symptoms caused by nerve compression due to the herniated disc.
Condition On Discharge
The patient was in a stable condition and was able to walk with full weight-bearing, indicating a good recovery from the surgery. She no longer experience radiculopathy, such as pain or numbness along nerve pathways, and their gait abnormality has notably improved. Most importantly, the patient is very pleased with the results of the surgery, indicating that they have experienced significant relief from their symptoms and are satisfied with their overall outcome.