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Abstract: The patient had low back pain with bilateral lower extremity numbness for more than 1 year. He was diagnosed with spondylolisthesis in a local hospital and underwent conservative treatment such as bed rest, oral medication and traditional Chinese medicine physiotherapy, but the symptoms were not relieved significantly, and the recurrent attacks were gradually aggravated, which seriously affected his normal life, so he came to our hospital for consultation. After confirming the patient’s condition, the patient’s back and leg pain and numbness were relieved and the quality of life was significantly improved after the internal fixation of spinal slippage repositioning decompression implantation fusion.
Basic information】Female, 60 years old
Disease Type】Spondylolisthesis (L4)
Hospital】Shanghai Long March Hospital
Date of consultation】November 2020
Treatment plan] Spondylolisthesis repositioning decompression implant fusion internal fixation (L4/5)
Treatment Period】7 days of inpatient treatment, 2 months of outpatient follow-up
Treatment effect]: Back and leg pain and numbness were significantly relieved, and walking was completely normal.
I. Initial consultation
The patient was a 60-year-old heavy woman who came to our clinic in November 2020. After taking a medical history, we learned that the patient began to experience discomfort more than a year ago, starting with simple lumbar pain, which later developed into numbness and pain in both legs. The numbness and pain radiated from the bilateral buttocks to the back of the bilateral thighs and calves, all the way to the back of the feet and the big toes. The numbness and pain in both legs increased significantly when walking and could only walk up to 100 meters, which could be slightly relieved after squatting down and resting. He was then seen at a local hospital and diagnosed with spinal slippage. Afterwards, on the advice of the local doctor, he underwent conservative treatment such as bed rest, oral medication and Chinese physiotherapy. At first, the symptoms improved, but with the increase in activity, the symptoms recurred and continued to worsen, and normal life was seriously affected, so he came to see the doctor.
In order to understand the specific condition of the patient, a lumbar MRI was prescribed, and the report showed lumbar degeneration, forward I degree slippage of the L4 vertebral body, stenosis of the L4/5 horizontal spinal canal, and compression of the dural sac. The outpatient diagnosis was: spondylolisthesis (L4). Therefore, the patient was admitted to the hospital.
II. Treatment history
The patient was recommended to undergo internal fixation of spinal slippage with decompression implant fusion (L4/5) on the premise that conservative treatment was ineffective and the symptoms were recurrent and progressively worsening. The surgery allowed complete removal of the nerve compressor, correction of the slippage, and restoration of the sequence of the lumbar spine, thus achieving relief of low back pain and numbness in both lower extremities. The surgical treatment plan was understood and approved by the patient and his family, and the operation was performed smoothly after the completion of the relevant preoperative examination.
III. Treatment effect
On the postoperative day, the patient felt significantly more relaxed in both legs than before surgery. On the first day after surgery, the patient reviewed the lumbar spine X-ray film, and the internal fixation position was good, and the lumbar spine slipped and repositioned satisfactorily. On the 3rd day after surgery, the patient got out of bed under the protection of the lumbar girth and could urinate and defecate normally. Except for some pain in the wound, the original lumbar pain and numbness of both lower limbs were basically relieved. On the 7th postoperative day, the patient was discharged from the hospital because of good recovery. At 12 days after the operation, the wound healed well and the stitches were removed smoothly. 2 months after the follow-up, the patient’s pre-operative symptoms were completely relieved and he was walking freely, and his physical condition was in good condition.
IV. Notes
We are glad that the patient’s symptoms of numbness and pain in the lumbar limbs were relieved after the surgical treatment, and he gradually regained his freedom of movement. Within one month after the spondylolisthesis, there may be recurrent symptoms of lumbar soreness and swelling and numbness in both lower extremities, but there is no need to worry too much at this time, as most of them are caused by blood accumulation in the postoperative wound or neuroedema, which will usually be relieved by bed rest or oral medication. In addition, post-operative spondylolisthesis patients are encouraged to perform strength exercises for the lower back and lower limbs in bed at an early stage, and gradually increase their activities after their strength has recovered, but avoid sitting for a long time, bending over significantly and bearing weight on the lumbar spine. In terms of diet, there is no special contraindication, except for avoiding blood-activating foods or drugs, and a normal diet is sufficient, but attention should be paid to weight control.
V. Personal insight
Most spinal slippage is related to degeneration, obesity, and sedentary, and some patients can have a history of trauma, which mostly manifests as pain in the lower back in the early stage, and as the disease progresses, symptoms of numbness and pain in the lower limbs caused by spinal stenosis can appear, which affects normal walking in serious cases. The vast majority of spinal slippage can be controlled by rest, drugs, Chinese physical therapy and other conservative treatment methods, when conservative treatment is not effective, recurrent symptoms, progressive aggravation, affecting the quality of life, surgery can be considered.