2. Salient Features
With kind permission from the Patient
Mrs. Sabina Yeasmin, 65 years old
diabetic, hypertensive housewife
hailing from Mymensing was admitted
in our unit on 23.12.20 with the
complaints of low back pain for last 2
years which was insidious in onset,
intermittent, mild to moderate in
intensity, gradually increasing,
aggravated after bending forward,
coughing, sneezing, straining during
defecation & relieved after taking rest
& oral analgesics.
3. Salient Features
Pain is non-radiating. She also complained of increasing pain
in lower back & cramping pain in both lower limbs after
standing for about 20 minutes or walking for about 200
meters which was relieved after taking rest in sitting or lying
position She didn’t give any history of trauma to the back,
limb weakness, prolonged fever, cough, hemoptysis, anorexia,
unusual weight loss or any other systemic complaints.
4. Salient Features
On examination, tone normal, muscle power is grade 5 in all
muscle groups bilaterally, ankle jerk diminished bilaterally,
plantar response flexor bilaterally, no sensory abnormalities,
SLR 80° bilaterally, femoral stretch test negative, FABER test
negative, no step off sign, all the spinal movements are
restricted due to pain, all the peripheral pulses are present.
18. Patient Position
• Positioned on a hall frame
• Hips and elbow flexed and
supported
• Torso flat
• Axillary, elbow, inguinal pads
• Abdomen should be hanging free
• No undue pressure on face/eye.
27. Closure
• Check for overall decompression
• Adequate haemostatis
• Irrigation with antibiotic impregnated saline solution
• Self retaining retractors are taken out
28. Closure
• After ensuring hemostasis, fascial
closure is done with 2-0 Vicryl and a
subcuticular closure is performed
on the skin
29. Complications
• Peroperative complications:
• Unintended durotomy resulting in post-operative
CSF leak
• Injury to the nerve root
• Retroperitoneal injury to great vessels and bowel
• Facet joint fracture
• Hemorrhage
• Positioning may lead to injury to the brachial
plexus, pressure points injury
• Wrong level surgery
30. Complications
• Post-operative complications:
• Wound infection, wound dehiscence
• Post operative discitis
• Failure of pain relief
• Segmental instability
• Recurrence of pain due to failed back surgery
syndrome