History:

A 59-year-old gentleman came to the OPD with complaints of bilateral lower limb radicular pain for the past one year, which had aggravated over the last one month. He also had mild lower back pain. There was a history of neuroclaudication on standing for less than 15 minutes and walking for less than 10 minutes. There was no history of tingling or numbness, no bowel and bladder complaints, and no history of sleep disturbance. The patient is a known case of diabetes mellitus and is on medication.

On Examination:

• No midline tenderness
• Heel and  toe walk possible
• ROM – extension painful

X-RAY Lumbosacral Spine Lat( Flexion / Extension)

• Osteophytes seen over LV1-5.
• Intervertebral disc spaces are normal.
• No abnormal translatory movement seen on flexion / extension views.

Operation Procedure:

Tubular L3-L4 laminectomy, bilateral foraminotomy with decompression was performed under general anaesthesia  under Unit 3 Orthopaedics, supervised by Dr. S. N. Patil. The operating surgeon was Dr. Sangram Rajale.

Radiological Investigations:-

MRI Lumbar Spine With Whole Spine Screening

Diffuse disc bulges at L3-4 level compressing the bilateral traversing nerve roots narrowing both lateral recesses and neural foramina compressing the existing nerve roots. 

Focal canal stenosis is seen at this level.

Before Surgery

Condition on Discharge:

1. Patient stable.
2. Vitally stable 
3. Afebrile
4. Suture line healthy and dry – no pus/discharge
5. Patient ambulating full weight bearing
6. Lower limb pain reduction 100%
7. Active ankle toe movements present 
8. Distal pulse felt