Transforaminal Lumbar Transforaminal Lumbar Interbody FusionInterbody Fusion

Presenting complaintsPresenting complaints

• 52 year female52 year female• Complaints of low back pain with bilateral Complaints of low back pain with bilateral

lower limb radiculopathy since 2 yearslower limb radiculopathy since 2 years

History of present illness History of present illness

• Leg pain > back pain (100:40)Leg pain > back pain (100:40)• Pain is present off and on Pain is present off and on • Claudication distance - few steps Claudication distance - few steps • Numbness present in both sides (left Numbness present in both sides (left

>right)>right)• No history of weight loss; trauma, feverNo history of weight loss; trauma, fever

Past history Past history

• Past history - Past history - nothing significant nothing significant • Hysterectomy done in 2004Hysterectomy done in 2004

examinationexamination• On examination On examination • SLR - bilateral 90 degreeSLR - bilateral 90 degree• Neurological examination at the time of admission-Neurological examination at the time of admission-• Bulk - comparable bilateral upper and lower limbs Bulk - comparable bilateral upper and lower limbs • Tone - normal in bilateral upper and lower limbsTone - normal in bilateral upper and lower limbs• Power - upper limbs - 5/5 bilateral, in all muscle groupsPower - upper limbs - 5/5 bilateral, in all muscle groups• Lower limbs - 5/5 bilateral, in all muscle groupsLower limbs - 5/5 bilateral, in all muscle groups• Reflexes - upper limb - BJ/TJ /SJ - comparable bilaterally Reflexes - upper limb - BJ/TJ /SJ - comparable bilaterally • Lower limb - KJ/AJ- comparable bilaterally Lower limb - KJ/AJ- comparable bilaterally •• Sensory - Paraesthesia in left feet in L5 and S1 dermatomeSensory - Paraesthesia in left feet in L5 and S1 dermatome• PAS - present PAS - present • VAC - present VAC - present

Final diagnosis Final diagnosis

• Lumbar canal stenosis L3-4; L4-5; L5-S1 Lumbar canal stenosis L3-4; L4-5; L5-S1

SURGERY DONE SURGERY DONE

• Operated on 13/11/2009 and TLIF of L4-Operated on 13/11/2009 and TLIF of L4-5; L5-S1 level done with 6 pedicle screws 5; L5-S1 level done with 6 pedicle screws (M8 Medtronics) and 2 PEEK cage (M8 Medtronics) and 2 PEEK cage (Capstone) with flavectomy of L3-4 level (Capstone) with flavectomy of L3-4 level done bilateral L4, L5 S1 roots done bilateral L4, L5 S1 roots decompressed. decompressed.