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History :
This patient came to Spine Specialist Doctor in Pune Dr. Sangram Rajale, who was a 50-year-old woman who had complained of low back pain along with radiating pain down her right leg for the past six months. She also experienced tingling and numbness in both legs. The pain worsened when she got up from a sitting position, sat for extended periods, or moved in bed. She could only walk for about 10 minutes before needing to rest, and standing for more than 15 minutes was difficult. These symptoms also disrupted her sleep.
MRI :
Degenerative Changes in Lumbar Spine: This means the structures in her lower back have worn down over time, which can lead to pain and reduced mobility.
Sclerosis with End Plate Erosion and Irregularity at L3-L5 Level: This indicates hardening of tissue and damage to the bony structures in the lower spine, likely contributing to her pain and discomfort.
Loss of L4-L5 Intervertebral Disc Space: There’s a reduction in the cushioning between the vertebrae at this level, which can cause nerve compression and pain.
Pseudo Disc Bulge at L4-L5 Level with Anterolisthesis: There’s an abnormal bulging of the disc material and forward displacement of one vertebra over another, which is likely putting pressure on the nerves and causing her symptoms.
DEXA SCAN
The DEXA scan result with a T score of -3.4 help explain the reason for the fracture and subsequent spinal issues requiring surgery. A T score of -3.4 indicates severe osteoporosis. Osteoporosis is a condition characterized by low bone density and weakened bone structure, making bones more susceptible to fractures even with minimal trauma or stress.
On Examination :
The patient had tenderness along the midline of her spine. She experienced pain when bending backward, reduced power and was unable to walk on her heels and toes properly. Her ankle (DF) and (PF) strength were rated at 3 out of 5, and her Toe (EHL) and (FHL) strength were rated at 3 out of 4. Straight Leg Raise (SLR) test was positive. She could walk for only about 10 minutes before experiencing claudication symptoms (pain or cramping due to reduced blood flow).
Operation :
On December 20, 2022, the patient underwent a posterior spinal fusion surgery at the L3-L4 and L4-L5 levels under general anesthesia by Best Spine Surgeons in Pune Dr. Sangram Rajale. This procedure involved using implants. The fusion surgery aimed to stabilize the affected spinal segments, alleviate nerve compression, and improve the patient’s overall spine function and quality of life.
Condition On Discharge :
a) The patient was stable and transferred to the ward.
b) The day after surgery, we assisted her in standing and taking a few steps.
c) By the second day post-surgery, she was completely free from pain and able to walk around the ward.
d) We removed her drain and encouraged her to climb stairs, which she found quite comfortable. Her muscle strength also improved gradually.
e) It has been 1.5 years since the surgery, and she is now completely free from pain, happily performing all her daily activities.