Dear Dr Sood,
I agree with Kevin, this patient is in dire need of yours or a neurosurgical colleagues surgical skills. My concern is that there is loss of bladder function, and severe bilateral leg pain. Is there any inco-ordination etc. of gait or signs of Cord compression? Certainly there are subjective signs of stenosis and cauda equina compression, and certainly in Australia (and obviously the UK from Kevin's comments) this warrents immediate surgical attention. Otherwise this poor man is likely to end up with a catheter and bag.
I also agree with Kevin that you should avoid extension.
---
Scott Epsley
PHYSIOTHERAPIST
Northside Sports Injury Centre
Brisbane, Australia.
e-mail: [log in to unmask]
On Fri, 29 Dec 2000 12:30:56
Dr. S.C. Sood wrote:
>Dear friends,
> When the year is coming to an end
>and so is another year of learning together and everyone is in Holiday
>Mood .I could not hold myself from presenting this case to all of my
>learned friends for there expert opinion.
> Yesterday evening an 58yrs old male came to my
>clinic presenting with severe pain in buttocks migrating to both legs with
>right foot drop.He is a shopkeeper with history of moderate
>back pain for which he went to our local infamous milkman who is famous for
>manipulations of spine .He put him in flexed position in standing then by
>pressing on lower back forcefully extending him he felt better at that time
>but latter that night when he went to toilet (Squatting position ) he was
>not able to get up due to weakness of right limb and he was unable to rise
>from that position and
>soon discovered his foot drop on the right side.
>Alarmed he went to one of ortho surgeon of city who gave him I.V steroids
>and put him on continuous lumbar traction for one week .with no relief .and
>now he has come to me with great expectation.There is no history of fever or
>any other disease.
>ON examination SLR is +ve on both sides Cough /sneeze/strain test is
>negative .Knee reflexes are-nt on both sides.He is losing control over
>bladder .
>He suffers from sever pain in both lower limbs soon as lift his head while
>in position .extension in lying peripherilizes right limb pain and
>centralize left limb pain.
>His MRI finding are as follow
>1.mild retrolishthesis of L5 over S1
>2.mild to mod diffuge bulge L3L4disc
>3.small posterro-lat right sided protrusion on right side L5S1 disc
>small Anterior epidural sub-acute HAEMATOMA OPP L3-L4 DISC MIDLINE/LEFT SIDE
>WITH MARKED THECAL SAC/ROOT COMPRESSION
>4.Mild Diffuge bulge D10-11,D11-D12.D12-L1,L1-L2 ,L2-L3,L4-L5 discs with
>prominent ligamenta flava leading to significant CANAL STENOSIS opp
>D10-11,D11-12 disc,
>
>DrSarveshwar Chander Sood
>Orthopaedic Surgeon & Head Department of Physical
>Medicine & Rehabilitation,
>Member American Academy Of Pain Management.
>S.B.L.S.Hospital
>812/1,Housing Board Colony
>Model Town,Jalandhar city
>Punjab State.India
>E-mail [log in to unmask]
>http://personal.vsnl.com/sarveshwar
>"For all the happiness mankind can gain is not in pleasure....but relief
>from pain."
>
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