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History :
58 year old lady came with complaints of low back pain and tingling and radiculopathy in B/L lower limbs since 10 years which was progressive in nature. She also complained of neuroclaudication i.e being able to walk only for 5-10 minutes following which she had to sit and rest. She was scared to under go the surgery as many people around her were telling her not to, for reasons best knowk to them. But whenthings went out of hand, she took the decision to undergo the surgery and was referred by one of my already operated patient
On Examination Of Spine:
The patient’s gait is normal, but she is unable to walk on her left heel due to power loss. She has full and free flexion of the lumbar spine, but extension causes pain.
MRI :
The MRI shows disc protrusions at four levels in your lower spine (L2-3, L3-4, L4-5, L5-S1). These protrusions are pressing on the spinal canal and nerve roots, which could explain pain, numbness, or weakness. Here’s a breakdown: Disc Protrusions: These occur at all four levels mentioned and narrow the spinal canal. Nerve Compression: The protrusions are compressing nerve roots on both sides at all levels except L5-S1, where the right side is more affected. L4-L5: An additional finding here is an “annular fissure,” which is a tear in the disc’s outer layer.
The MRI findings of central disc protrusions at multiple levels in the lumbar spine, along with narrowing of the spinal canal and compression of the nerve roots, are directly related to the patient’s complaints.
Low back pain:
The central disc protrusions and narrowing of the spinal canal can cause pressure on the spinal cord and nerves, leading to low back pain.
Tingling in both lower limbs:
Compression of the nerve roots at multiple levels can result in tingling sensations that radiate down both legs, known as bilateral lower limb radiculopathy. Neuroclaudication: The episodes of neuroclaudication (temporary leg weakness) lasting 5-10 minutes are likely due to the compression of nerve roots affecting motor function in the legs. Difficulty walking on left heel: The power loss mentioned in the left heel walk is likely due to nerve compression affecting muscle strength and control. Slipping of footwear: This could be related to the neurologic symptoms affecting sensation and motor function in the feet and legs. Overall, the MRI findings support the patient’s complaints of chronic low back pain, tingling in both lower limbs, neuroclaudication, and difficulties with motor function in the legs. These symptoms are consistent with lumbar spinal stenosis and nerve root compression due to disc protrusions
Operation :
The surgery involved fixing (stabilizing) the posterior-lateral aspect of the L2-L5 vertebrae (using screws and rods) on December 28, 2022. The surgery was conducted while the patient was under general anesthesia, by Dr. Sangram Rajale. The implants were used during the surgery.
Condition On Discharge :
Power:
EHL (Extensor Hallucis Longus muscle):
Improved from 1/5 to 5/5
EDL (Extensor Digitorum Longus muscle):
Improved from 1/5 to 5/5
Ankle:
Plantar Flexion (PF):
Improved from 0/5 to 5/5
Dorsiflexion (DF):
Improved from 1/5 to 5/5
Overall, the after the surgery she shows significant improvements in muscle strength, particularly in the EHL, EDL, and ankle movements (PF and DF).