These are images of a 57 years old male patient who underwent L2L3 discectomy with laminectomy before two years for acute cauda equine syndrome. He has now regained power and sentations upto L4level. He has bilateral foot drop with claw toes and severe intermittent painful spasms in the lower limbs. He has some bladder sensations but no bowel control.His slr is normal and both knee jerks are very weak with absent ankle jerks and high extensor tone witn non responsive planter.
The upper limbs have brisk jerks with normal motor strength. He says he did have paresthesias and numbness in all four extremities before surgery. It was only after two months of surgery that he noticed these severe spasms which are very painful. He has no complains for the upper limbs as such.
The images show a bad cord compression with cord oedema in the cervical spine and arachidonitis with stenosis at L3L4 and L4L5 levels.
I would appreciate to know the further management. What should be at the priority?Does he need both the
cervical and lumber decompressive surgeries? If so what should be the ideal cervical surgery?
Any further investigations required?
Regards,
Rajendra
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