History:
Mrs. Nandalwar, a 55-year-old female, presented with a 5-month history of persistent low back pain accompanied by left-sided radicular pain. The pain worsened with prolonged sitting, standing, and walking. She also experienced numbness in the left lower limb. There was no history of trauma, bowel or bladder dysfunction, or sleep disturbances. Mrs. Nandalwar is a known case of diabetes mellitus for the past 6 years and has a medical history of leprosy diagnosed 30 years ago. Her clinical presentation indicates possible nerve involvement, warranting further evaluation and management for chronic low back and radicular pain.
On Examination:
Forward stooped posture with antalgic gait: The patient walked with a noticeable forward bend and an antalgic gait pattern, indicating an attempt to reduce pain while walking.
Difficulty with prolonged standing or walking: She was unable to maintain standing or walking for extended periods due to increased discomfort and pain.
No distal neurological deficits: Neurological examination of the lower limbs revealed no signs of weakness, sensory loss, or reflex abnormalities in the distal areas.
Radiological Findings:
MRI Lumbo-Sacral Spine + Whole Spine Screening (18/09/2023):
L4-L5 disc prolapse with listhesis: Evidence of disc herniation at the L4-L5 level along with vertebral slippage, suggesting instability at this segment.
Degenerative disc disease at L2-L3: Signs of disc degeneration were noted at the L2-L3 level, indicating age-related or wear-and-tear changes.
Old vertebral injury changes at L3: MRI showed chronic changes suggestive of a past vertebral injury at the L3 level.
Surgical Management:
Mrs. Nandalwar underwent L4-L5 Soft TLIF (Transforaminal Lumbar Interbody Fusion) surgery on 22nd September 2023 under general anesthesia. The procedure was successfully performed by Dr. Sangram Rajale, with spinal stabilization achieved using Sky Surgicals implants. This surgical intervention aimed to relieve nerve compression, stabilize the affected spinal segment, and alleviate chronic low back and radicular pain.
Postoperative Progress and Discharge Condition:
The patient remained clinically stable throughout the postoperative period.
No fever or wound-related complications were observed.
The suture line was clean and dry, indicating proper wound healing.
She was able to walk independently with full weight-bearing using walker support.
Active movements of the toes and ankles were preserved.
There was no evidence of distal neurovascular compromise.
Recovery:
Radicular pain significantly improved following surgery, providing substantial relief to the patient.
Spinal alignment was corrected, leading to a noticeable reduction in back pain.
The patient is now able to ambulate independently with the help of support.
Ongoing improvement in functional ability and mobility is being achieved through regular physiotherapy sessions.
Regular follow-up has been advised to monitor the progress of spinal fusion and ensure long-term recovery.