Concluded Case

Multiple Disc Dorsal and Lumbar with two stage surgery.

New case. 68 yr,F, Knowm DM on insulin ,hypertensive ,DLP,presented with back pain diffusely in the back since 4 yrs.For 4 months she has worsening of symptoms with radiation of pain to both lower limbs Lt > Rt .For 25 days she is having severe pain in the back with difficulty in walking associated with numbness below the lower chest.Also has unsteadiness of gait,and tingling sensation around the chest in the mid thoracic area with pain while turning in the bed.For the last 1 week she is having hesitancy and precipitancy of micturition,difficult to hold the urine ,prevoid dribbling with intact sensation of passing urine.On exam gr 3/ 5 power in the lower limbs with normal power in the upper limbs, spasticity in the lower limbs, hyperactive knee jerks ,normal ankle jerks,bilateral extensor plantars with dulling of sensation below D6. Diagnosis and management? Currently ,pt is under the spinal surgeon.

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Concluded answer

Thanks for the answers. * Disc bulge with osteophytic changes noted fromD1- D5 with partial obliteration of thecal sac& narrowing of spinal canal. * Neural foramina narrowing on D3 to L1. * Significant spinal canal narrowing D34,D4-5& D12 - L1. * Thickening of PLLat D3 to D5 & D12 toL2 levels noted. * Ligamentum flava HYPERTROPHY D3-4,D4-5 D7-to L1 level. poor prognosis was explained to the patient and relatives in view of the physical findings with bladder involvement. The family agreed for surgery and surgery was done in 2 stages. 1st stage : Anterior& posterior decompression at D3,4 ,5 + costoctomyD4 5 Rt side,posterior decompression & posterior instrumentation D3 to D7 under GA. Stage 2 procedure done after 4 days- D12 to L5 with bilateral laminectomyL4- 5 TLIF & fecectomy D12 - L2 ,posterior instrumentation under GA.

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Thanks for the answers. * Disc bulge with osteophytic changes noted fromD1- D5 with partial obliteration of thecal sac& narrowing of spinal canal. * Neural foramina narrowing on D3 to L1. * Significant spinal canal narrowing D34,D4-5& D12 - L1. * Thickening of PLLat D3 to D5 & D12 toL2 levels noted. * Ligamentum flava HYPERTROPHY D3-4,D4-5 D7-to L1 level. poor prognosis was explained to the patient and relatives in view of the physical findings with bladder involvement. The family agreed for surgery and surgery was done in 2 stages. 1st stage : Anterior& posterior decompression at D3,4 ,5 + costoctomyD4 5 Rt side,posterior decompression & posterior instrumentation D3 to D7 under GA. Stage 2 procedure done after 4 days- D12 to L5 with bilateral laminectomyL4- 5 TLIF & fecectomy D12 - L2 ,posterior instrumentation under GA.

D 3/4 level cord compression D12/L1 level canal stenosis Cervical degenerative disc disease with indentation of cord Radiologist report? Neurosurgery evaluation

Requires dorsal level surgery . Can discuss and call over 9873734192.

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