History :
This is about a 30-year-old man who came to see me in my clinic because his back hurt and the pain was also going down both of his legs. This had been happening for about 2 months, but in the last 4 days, the pain got much worse. During that time, he could not walk, stand, sit, or do his usual daily activities at work. When he first came to the clinic, we gave him some pain medicine and suggested getting an X-ray. The X-ray looked normal at first, so we advised him to do some physical therapy exercises and try conservative management (non- surgical treatment). However, after a few days, his pain became so severe that he could walk or stand at all. That is when we decided to do an MRI scan, which showed that he had a disk in his spine that was causing pressure on his spinal cord, leading to his symptoms. After seeing the MRI results, we decided that surgery was the best option to help him feel better.
The patient exhibited gait abnormalities characterized by an inability to walk in a straight line, noticeable bending to one side, and limping. Additionally, during physical examination, the patient displayed limitations in forward and backward bending movements.
MRI :
L5/S1 Level:
There is a mild disc bulge: This means that one of the discs between the vertebrae in the lower back is slightly bulging out. Right paracentral disc protrusion and extrusion: This indicates that the disc has moved slightly to the right side and is pushing out beyond its normal position. Compression over ventral thecal sac: The bulging and protrusion of the disc are causing pressure on the front part of the protective covering around the spinal cord.
L4/5 Level:
Mild disc bulge: Similar to L5/S1, there’s a slight bulging of the disc. Posterocentral annular tear: There’s a small tear in the outer part of the disc towards the back.
In summary, the MRI shows that at both the L5/S1 and L4/5 levels, there are issues with disc bulges and protrusions, with the L5/S1 level causing more compression on the spinal cord coverings and nerves compared to the L4/5 level.
Operation :
On October 20, 2023, a microdiscectomy surgery was performed on the L5-S1 level of the spine. This surgery involved removing a small portion of the disc material that was causing compression or irritation of nearby nerves. The procedure was done under general anesthesia, meaning the patient was asleep during the surgery. The surgery was carried out by Dr. Sangram Rajale, and no implants were used during the procedure.
Condition On Discharge :
a. Patient stable in the post operation.
b. He had complete pain relief next day of the surgery.
c. We medium walk in the world climb stairs.
d. He was discharged on the second day of surgery.
e. On follow up after 15 days he had already started his job.
f. Over the period of next 3 to 4 months he was completely pain free and now is doing everything.