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Abstract: Congenital anomalies are organ as well as structural abnormalities that occur at the time of fetal birth. In this case, the patient was a 38-year-old female who was frequently troubled by lumbar pain for 13 years without formal treatment, and the pain worsened after activity and relieved after rest. After coming to our hospital, a 3D reconstruction of the lumbar spine CT was performed, and the diagnosis was lumbar spinal stenosis combined with congenital scoliosis, of which congenital scoliosis is a kind of congenital malformation, and the symptoms were relieved after surgery was recommended.
Basic information】Female, 38 years old
Disease Type】Congenital scoliosis, lumbar spinal stenosis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Consultation time】November 2018
Treatment plan】Surgical treatment (posterior lumbar 4/5 discectomy decompression implant fusion internal fixation)
Treatment period】7 days of hospitalization and regular postoperative follow-up
【Treatment effect】The patient’s lumbar pain and lower limb pain disappeared, and there was no significant discomfort when moving down to the ground
I. Initial interview
In November 2018, a middle-aged woman came to the clinic. The patient reported that she was often troubled by lumbar pain for 13 years, and the pain was good and bad, and the pain would worsen with more activities and would be relieved somewhat after rest, during which she did not undergo formal treatment. In the past 2 years, the pain in the left thigh and calf has been throbbing, and at first it took a break to walk a few hundred meters, but slowly it became impossible to walk even a hundred meters, and it took a break to walk. So he came to our hospital. After communicating with the patient, the necessary diagnostic tests were performed, including full-length frontal and lateral spine and 3D reconstruction of the lumbar spine, which revealed a C-shaped curvature of the lumbar spine; MRI of the lumbar spine showed lumbar 4/5 spinal stenosis; and physical examination showed lumbar pain with a positive left straight leg raising test. The diagnosis was lumbar spinal stenosis combined with congenital scoliosis, of which congenital scoliosis is a kind of congenital malformation.
II. Treatment history
The diagnosis was clear, and the patient was admitted to the hospital for treatment. We communicated with the patient and family that we could consider minor surgery to solve the patient’s current back and leg pain problem, with the advantages of less trauma, less cost, and faster recovery; we could also consider major surgery to solve congenital scoliosis at the same time, with the advantages of solving the problems of scoliosis and lumbar spinal stenosis at the same time and improving the aesthetics, but with more trauma and cost. After consideration by the patient and her family, they decided to solve the pain problem that was currently bothering her, so they first performed a minor surgery, namely posterior lumbar 4/5 discectomy decompression implant fusion internal fixation. During the operation, the nerve roots were carefully manipulated to fully expose the nerve root canal and to enlarge it sufficiently to reduce the local compression symptoms.
III. Treatment results
The patient underwent posterior lumbar 4/5 discectomy, decompression, bone graft fusion and internal fixation, after the operation, the patient’s back pain was significantly relieved, and the pain in the left lower limb was also significantly relieved, and he could move on the ground as normal 2 days after the operation. One month after the operation, the X-ray film showed that the position of the internal fixation was good. 1 year after the operation, the scoliosis was not aggravated, and the position of the internal fixation of the lumbar spine was satisfactory, and the lumbar pain disappeared completely, which did not affect the daily work life, and the patient and his family were very satisfied.
IV. Notes
The patient’s pain symptoms were significantly reduced after surgery, and he could walk on the ground normally, so he was truly happy for him. Even though he was discharged from the hospital, he was advised not to take the recovery period lightly, and the normal review time is 1 month, 3 months, 6 months, 1 year and 3 years. After returning home, you should pay attention to the lower limb activities and urination and defecation. 3 months after returning home, you can carry out muscle strength exercises for the lower back, such as hanging bar, push-ups, sit-ups, swimming, etc. In daily work life, avoid sedentary, sedentary is more harmful to the lumbar spine, after sedentary can properly stand up to move the waist. There is no contraindication in diet, you can eat healthily according to the diet.
V. Personal insight
The patient in this article is a special case of lumbar spinal stenosis combined with congenital scoliosis. After the CT and MRI of the lumbar region helped to diagnose the patient, we chose a minor surgery to solve the patient’s main symptoms after communicating with the patient’s family, so that she can return to normal life and avoid the trauma caused by major surgery. Many times choosing an appropriate treatment plan based on the patient’s complaints is a boon to the patient. Congenital scoliosis is a disease suffered at birth, which is more pronounced during adolescence and can have a negative impact on the patient’s appearance, so early detection and treatment should be done as early as possible when the patient is a child.