Microdiscectomy Week1&2 - Hospitalization - Post Op

Day 1: Fully on bed. Impact of General Anaesthesia was horrible. I was fully on drips. No liquid or solid foods allowed due to fear of vomitting. Lips were dry and literally I was begging to get a few drops of water.
Day 2 and Day 3: Still on bed. Only liquid food - juices, soup and tender coconut. Still on drips.
Day 4: Was made to sit and walk.

• Started with solid foods
• Started with small walks of 10m and slowly reached 50m by end of the week
• Remember to weak back belt always - particularly when you get up/into bed and when you go for toilet.
• Use proper posture to get out of bed without twisting your back.

Complications: Urinary Bladder weakness and Constipation

Microdiscectomy Surgery - 09/Feb/2011

Spinal Decompression along L3-L4 and L4-L5
Microdiscectomy done at L4-L4 level

Operation Notes: Patient prone on OT. Midline skin incision over L2-L5. L3-L4 spinous process split using burr. Midline fenestration done at both levels. L4-L5 extruded disc removed.
Findings: End plate avulsion seen at L4-L5. End Plate attached to the extruded disc. Incidental dural tear sutured with 6.0 vicryl. Tisseal applied. Wound closed in layers. Suction drain.

MRI Scan - Dec 2010 - Detailed Report

Mr.Sivakumar (M/37years)
3T MRI – LUMBOSACRAL SPINE
Dec 11th 2010

Sequences
Sagittal - T2,T1
Axial -T2
Coronal -T2FS,T2Neurography
MR Mylogram


Observation:
• Scoliosis visualized with convexity to the right.
• Degenerative changes noted in the form of anterior and posterior osteophytes.
• Diffuse disc bulge with annular tear noted in L1-L2 with right posterocentral herniation causing ventral the cal sac indentation and mild spinal canal stenosis with bilateral neural foramina narrowing (right>left).
• Asymmetrical diffuse disc bulge along with disc extrusion and annular tear noted in L3-L4 with ventral thecal sac obliteration and sever spinal canal stenosis and neural foramina narrowing impinging on bilateral traversing nerve(left>right).
• Asymmetrical diffuse disc bulge with annular tear noted in L4-L5 causing ventral thecal sac obliteration and sever spinal canal stenosis and neural foramina narrowing – impinging on bilateral traversing nerve (left>right).
• Ligamentum flavum hypertrophy visualized in L3-L4 and L4-L5.
• Facet arthrosis with hypertrophy noted in L3-L4 and L4-L5 levels.
• Disc extrusion in L3-L4 andL4-L5 along with inferior migration in L4-L5.
• The vertebral bodies appear normal. No collapse/bone destruction. No spondylolisthesis.
• No evidences of primary canal stenosis.
• Neural arches of the lumbar vertebrae appear normal.
• Rest of the lumbar intervertebral discs appear normal. Disc height is maintained.
• Rest of the neureal foramina apperar normal
• The sagittal diameters of the llumbar spinal canal are as follows (in mm).
o L1-L2 : 11.5MM
o L2-L3 : 15MM
o L3-L4: 6.2MM
o L4-L5 : 7.4MM
o L5-S1 : 10MM
• Conus medullaris and cauda equine nerve roots appear normal.
• Sacroiliac joints appear grossly normal.
• The perivertebral soft tissues are unremarkable.

Impression:
• Scoliosis visualized with convexity to the right.
• Diffuse disc bulge with annular tear in L1-L2 with right posterocentral gerniation causing ventral thecal sac indentation and mild spinal canal stenosis with bilateral neural foramina narrowing(right>left).
• Asymmetrical diffuse disc bulge along with disc extrusion and annular tear in L3-L4 with ventral thecal sac obliteration and severe spinal canal stenosis and neural foramina narrowing – impinging on bilateral traversing nerve (left>right).
• Asymmetrical diffuse disc bulge with annular tear in L4-L5 causing ventral thecal sac obliteration and severe spinal canal stenosis and neural foramina narrowing – impinging on bilateral traversing nerve (left>right).
• Ligamentum flavum hypertrophy and facet arthrosis with hypertrophy visualized in L3-L4 and L4-L5. Disc extrusion inL3-L4 and L4-L5 along with inferior migration in L4-l5.

MRI Scan - Key Findings - Dec 2010

Severe Stenosis at L3-L4 and at L4-L5.
Disk Extrusion at L3-L4 and at L4-L5.

Symptoms - Dec 2010

• No bending at waist – just 10 degrees
• Leg lift in both lefts are about 30 degrees
• Numbness in right leg – back side of thigh, back side of calf, sole and toes
• Severe sciatic pain along right leg at slightest jerk
• No urinary or bladder related symptoms