Patient Name : Mr. Dhumal
Age : 78 years
Introduction
This is the case of a 78-year-old gentleman from Pune who presented with severe lower back pain and left leg pain due to L4-L5 and L5-S1 lumbar canal stenosis. His walking tolerance had reduced to only 10 minutes because of neurogenic claudication, and sleep was significantly disturbed. After undergoing minimally invasive lumbar decompression and percutaneous posterior spinal fixation, he achieved complete pain relief and now walks and stands for more than an hour comfortably. This case highlights the effectiveness of minimally invasive spine surgery in elderly patients.
Patient History & Presentation
The patient experienced:
- Lower back pain for 20 day
- Left leg radiculopathy
- Pain worsening during walking, sitting, and standing
- Neurogenic claudication at 10 minutes of walking
- Sleep disturbance due to pain
- No bowel or bladder involvement
Medical history:
- Coronary angioplasty done in 2018
- On regular cardiac medications
Clinical Examination:
- Gait: antalgic
- Flexion: normal
- Extension: catch present
- Power: left FHL 4+/5, rest 5/5
- Reflexes normal
- Slouch test: positive bilaterally
- Sensations: intact
- Distal pulses: palpable
The presentation was consistent with degenerative lumbar spine disease, causing severe nerve root compression.
Diagnosis & Radiological Findings
X-ray Findings:
- Lumbar spondylosis
- Osteophytes from L1–L5
- Disc space narrowing at L5-S1 with vacuum phenomenon
MRI Findings:
- Multilevel degenerative disc disease
- Disc bulge and posterior canal protrusion at L4-L5 and L5-S1
- Bilateral nerve root indentation
- Grade 1 retrolisthesis at L1-L2 and L2-L3
- Moderate-to-severe lumbar canal stenosis
These findings confirmed L4-L5 & L5-S1 lumbar canal stenosis with mechanical and neural compression.
Surgical Procedure
The patient underwent:
L4-L5 and L5-S1 Laminectomy
- Removal of lamina to decompress the thecal sac
- Release of trapped nerve roots
Discectomy
- Removal of compressive disc material
Percutaneous Posterior Spinal Fixation (MIS Technique)
- Minimally invasive approach
- GESCO implants used
- Reduced blood loss & faster recovery
People Also Ask (Search Intent Optimization):
- Is spine surgery safe in elderly?
Yes, with modern MIS techniques, spinal surgeries are safe even in elderly patients with comorbidities. - How effective is decompression for stenosis?
Very effective when nerve compression is severe and mobility is affected.
Post-Operative Recovery
- Day 1: Walking full weight-bearing
- Day 2: Stair climbing
- Wound clean, no soakage
- Afebrile, stable vitals
Neurological status improved significantly.
Long-Term Outcome (3 Months)
- 100% relief from back pain
- 100% relief from left leg pain
- No tingling or numbness
- Walking > 1 hour
- Standing > 1 hour
- Zero recurrence of symptoms
- Extremely satisfied that he chose surgery despite relatives discouraging him
This is a classic example of successful minimally invasive spine surgery in senior patients.
Why Surgery Was Necessary
- Severe compression of nerve roots
- Rapidly declining walking tolerance
- Sleep disruption
- Failure of positional and conservative measures
Imaging showed advanced stenosis
Surgery prevented neurological worsening and restored independent mobility.
About Dr. Sangram Rajale
Dr. Sangram Rajale is a leading Spine Surgeon in Pune, specializing in Minimally Invasive Spine Surgery, Endoscopic Spine Surgery, and Decompression Procedures.
He practices in Bavdhan, Pune, and is known for excellent outcomes in elderly spine patients.
FAQs
A narrowing of the spinal canal causing nerve compression.
Yes, MIS techniques make it safe and effective.
Most patients walk within 24 hours.
Leg pain, numbness, claudication, weakness, or difficulty standing/walking.
Yes, they result in faster recovery and minimal muscle damage.