LCS Dr Rahat V2sjjsnsksoosnsnsmdkkkks.pptx

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1. Welcome to Case Presentation Dr A. M. Rahat Bin Amin MS Phase B Resident Violet unit-2

2. Particulars of the patient Name : Md Jakir Age : 45 years. Occupation : Day Labourer Address : Barkal , Rangamati Ward/Bed : NB-627 Reg. No : 531406 DOA : 03.10.24

3. Presenting complaints 1. Low back pain for 2 years. 2. Difficulty in walking for 6 months.

4. H/O Present Illness According to the statement of the patient he was reasonably well 2 years back. Then he noticed pain in lower back region . The pain was initially mild, dull aching, localized and non radiating. The intensity of pain is gradually increasing and for the last 6 months it radiates to both lower limbs .

5. History of present illness cont … Pain is aggravated by standing upright and walking and relieved by sitting and leaning forward . Pain is less experienced in walking up stairs than down stairs . H e also complained of difficulty in walking due to pain, pain appears at variable distance. Initially he could walk for 10-15 minutes at a stretch, but now not more than 5-7 minutes.

6. History of present illness cont … For this reason, he consulted with different physician and took treatment in the form of analgesics and physiotherapy but symptoms not relieved. With these complaints he got admission to NITOR through OPD. On query, his bowel and bladder habit is normal. He gave no history of fever, weight loss, anorexia or any constitutional symptoms .

7. General Examination Appearance : Anxious Body built : average Nutritional status : average Decubitus : supine Anaemia : mild Pulse : 80 /min BP : 110/80 mmHg Temp : Normal Oedema : Absent Dehydration : Absent

8. Locoregional Examination Look: Increased lumbar lordosis. Transverse loin crease Flat buttock > Gait: Normal > Squatting: possible with difficulty > Heel Walking: possible with difficulty > Toe walking: possible

9. Feel: > Temp: Normal > Tenderness: present at lower back > No p alpable stepping present Sensory: Diminished at 1 st web space of both feet Muscle Power : EHL (both side)-4/5, Others-5/5 >Reflex: Knee jerk : Normal Ankle jerk : Normal > Vascular: ATA,ADP,PTA palpable

10. Special Test: SLR Test : Negative Cross SLR Test : Negative Lasegue Test : Negative Bowstring test : Negative FABER Test : Negative

11. Systemic Examination >> All the systemic examination reveals no abnormalities.

12. Provisional Diagnosis Lumbar Spinal Canal Stenosis, most probably due to degenerative cause

13. X-ray L/S Spine A/P and Lateral

14. Dynamic Flexion Extension View

15. Pelvic Balance

16. Angular instability

17. Oblique view

18. MRI

19. Diagnosis: • Lumbar Spinal Canal Stenosis with Spondylolisthesis of L 4 Over L5 ( Meyerding grade: I, Degenerative type). Unit plan: • Posterior decompression by laminectomy, stabilization by pedicle s c rew s and rods and interbody fusion by using Banana Cage with autogenous cancellous bone graft .