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Abstract: Spinal slippage is a relatively common spinal disorder, which refers to the abnormal forward displacement of the upper vertebral body relative to the lower vertebral body, mostly seen between the lumbosacral vertebrae. The patient in this case presented with numbness and weakness in the left lower extremity, and was diagnosed with spondylolisthesis after examination. Since the patient’s slipped vertebrae had already fused, the surgery did not reset the slipped vertebrae, but released the nerve compression. After surgery, the patient’s left lower extremity discomfort was significantly relieved and walking function was gradually restored.
Basic information】Male, 64 years old
Disease Type】Spondylolisthesis
Hospital】The First Hospital of Harbin Medical University
Date of consultation】March 2022
Treatment plan】Lumbar posterior decompression and internal fixation + cefazolin sodium for injection and anti-infection
Treatment Period】Inpatient treatment for 14 days, regular outpatient follow up
Effectiveness】Numbness and weakness of the lower limbs were significantly relieved, and normal walking function was gradually restored.
I. Initial consultation
The patient is a farmer who often works in the field. He had lumbar pain about 15 years ago, but did not pay attention to it and did not treat it. Recently, in May, he gradually developed weakness and numbness of the left lower limb with soreness and swelling, which was aggravated after bending, working and walking, and relieved after resting in bed. On examination, we could find that the patient’s lumbar region was stiff, and a distinct “step” feeling could be touched, and the left toe flexion and extension were weak with skin numbness.
II. Treatment process
After admission, the patient was further examined, and the patient was perfected with lumbar hyperextension and hyperflexion x-ray, lumbar front and lateral x-ray, lumbar spine MRI and lumbar spine CT, and it was found that the slipped vertebra had fused, but the posterior spinal canal of the vertebra was severely degenerated and narrowed abnormally, and the nerves were obviously compressed. At the same time, the patient completed routine preoperative preparations such as routine blood work, liver and kidney work, coagulation items, ECG, and chest X-ray, and prophylactic application of cefazolin sodium for injection to anti-infection before surgery, and the patient underwent posterior lumbar decompression internal fixation on the third day after admission, and the drainage tube was removed on the second day after surgery, and the patient was discharged 14 days after hospitalization.
III. Treatment results
The patient’s incision healed well without abnormal manifestations such as infection and necrosis, and the stitches were removed from the incision 2 weeks after the operation. On the second day after the operation, the patient felt pain in the operated area of the lumbar region, and there was numbness and discharge in the left lower extremity, but the symptoms of weakness improved significantly. On the 5th day after surgery, the numbness and discharge sensation of the left lower limb was relieved. On the 3rd day after surgery, the patient left the bed and moved on the floor under the protection of a lumbar brace. At the time of discharge, the patient could move normally under the protection of the lumbar brace, and there was no obvious discomfort in the lumbar region, and the symptoms of numbness and weakness of the left lower limb were significantly relieved compared with those before surgery.
IV. Notes
We are glad that after the treatment, the patient’s symptoms of the left lower limb are relieved and walking is back to normal. The patient does not need to be bedridden after discharge and can exercise under the protection of lumbar support. The lumbar brace should be worn during daytime exercise, but not at night when sleeping. The lumbar brace should be worn for 3 months, during which time discomfort should be followed up. Try to turn over axially at night within 6 weeks after surgery to avoid twisting of the lumbar region, and take X-ray review at 3 months, 6 months and 1 year after surgery. After surgery, avoid trauma and heavy physical work, but daily activities are allowed, and the internal fixation can stay in the body for a long time without taking out.
V. Personal insight
When suffering from spinal slippage, many patients are concerned about whether the surgery can reset the slipped vertebrae. The patient in this case had a history of lumbar spondylolisthesis for many years and had lumbar pain in early years. The imaging showed that the slipped vertebrae had fused spontaneously with each other and stability had been restored between the spine.