Case report 1: SPONDYLOSIS
Diagnosis: Lumbar spondylosis / Degenerative disc disorder / Lumbar canal stenosis
Treatment: Spinal Decompression, Instrumentation and Bony fusion.
A forty five year old lady had chronic back pain for more than four years. She underwent medical management and physiotherapy on and off with temporary relief of back pain. However she started developing aching thigh and leg pains along with severe back pain, which restricted her mobility significantly for the past twenty days.
Investigations showed significant lumbar spine diseases – lumbar spondylosis, degenerative disc bulge, facet dystrophy and secondary canal stenosis at lumbar 4 and 5 vertebral level.
Degenerative lumbar spine produce back pain and lumbar canal (which contains the nerves and blood vessels) stenosis produces thigh and leg pain due to venous stasis in the spine causing congestion of the nerve roots.
A definitive surgical management provided good relief of patients’ symptomatology. Spinal decompression (subspinous laminectomy) released venous stasis and neural compression, spinal instrumentation (Pedicle screw – rod fixation) provided support to the degenerative spinal level and posterior lumbar inter body fusion (PLIF), posterolateral inter transverse fusion with autologous (patients own iliac crest) bone graft provided good fusion at the L4 L5 segment.
Post-operatively patient was provided with a brace and gentle mobilization. The patient is symptom free in first two weeks time and started walking comfortably.
Case report 2: SPONDYLOLYSIS
Diagnosis: Spondylolysis – Defect in the pars
Treatment: Spinal stabilization & grafting
Pars is a bony structure in the spine which connects the vertebral body and the posterior spinal structures like lamina & spinous process. Occasionally this structure may be thin or may not have formed. A thin pars may get fractured following trivial injury. This will cause severe back pain, which may get well with bed rest.
Healing of the pars defect invariably relieves back pain. In cases of failure of fusion with conservative management fails. Spinal stabilization will provide optimal enviroment for the pars to fuse.
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