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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