Successful Laminectomy and Discectomy for Lumbar Disc Prolapse in a 74 Y.O. Female

PACE Hospitals’ expert Neurosurgery team successfully performed an L1–L2 Minimally Invasive  Laminectomy and Discectomy on a 74-year-old female patient diagnosed with L1–L2 intervertebral disc prolapse with cauda equina compression. The aim of the procedure was to relieve pressure on the compressed nerve roots and cauda equina, alleviate pain and neurological symptoms, and restore spinal stability and function through a minimally invasive approach.

Chief Complaints

A 74-year-old female patient with a body mass index (BMI) of 22 presented to the Neurosurgery Department at PACE Hospitals, Hitech City, Hyderabad, with low back pain and right lower limb radiculopathy of 10 days’ duration. She subsequently developed inability to move her right leg along with weakness in her left leg. Initially, her pain was relieved with medication, but it later persisted even at rest and did not respond to medical management.

The patient had a past medical history of hypertension, which was well-controlled on medication. She had no history of trauma, fever, or previous spine surgeries, and no other significant systemic illnesses were reported.

On examination, the patient was conscious, coherent, and oriented. She was moderately built and nourished. Cardiovascular and respiratory systems were normal on clinical assessment. The abdomen was soft and non-tender. Neurological examination revealed reduced power in both lower limbs, more pronounced on the right side, with diminished reflexes and absent plantar responses.

Upon admission, the patient underwent a comprehensive clinical evaluation along with the patient’s medical history and diagnostic investigations conducted by the Neurosurgery team.

Laboratory and special investigations were conducted as part of the preoperative assessment. Complete blood counts (CBC) were within normal limits. Viral screening for HIV, Hepatitis B, and Hepatitis C was negative. Renal function tests and serum electrolytes were stable. Chest X-ray demonstrated normal heart size and clear lung fields.

Neuroimaging investigations, including Magnetic Resonance Imaging (MRI) of the lumbosacral spine, demonstrated L1–L2 intervertebral disc prolapse with cauda equina compression.

Based on the confirmed diagnosis, the patient was advised to undergo Intervertebral Disc Prolapse Treatment in Hyderabad, India, under the expert care of the Neurosurgery Department.

After a detailed consultation with Dr. U.L. Sandeep Varma, Consultant Neurosurgeon, along with cross-consultation by Dr. Mugdha Bandawar, Consultant Obstetrician & Gynaecologist, a comprehensive postoperative neurological assessment and overall evaluation were performed to determine the most appropriate management and therapeutic approach. The patient presented with severe low back pain, bilateral lower limb weakness, and radiculopathy, and neuroimaging confirmed L1–L2 intervertebral disc prolapse with cauda equina compression.

The clinical evaluation revealed significant neurological deficit in both lower limbs, with reduced motor power and absent plantar reflexes on examination. It was determined that L1–L2 minimally invasive laminectomy and discectomy under general anaesthesia was identified as the most appropriate surgical intervention. This procedure was aimed at decompressing the affected nerve roots, relieving pain, restoring neurological function, and preventing further deterioration.

The patient and her family members were counseled in detail regarding the diagnosis, surgical intervention, postoperative care, pain management, physiotherapy, medication adherence, and the need for regular follow-up to optimize recovery and functional outcomes.

Following the decision, the patient was scheduled to undergo a L1–L2 minimally invasive laminectomy and discectomy Surgery in Hyderabad at PACE Hospitals, under the expert supervision of the Neurosurgery Department.

The procedure involved the following steps:

• Preoperative Preparation: The patient was positioned and prepared under strict aseptic precautions. The surgical site was painted and draped, and the L1-L2 level was precisely localized using fluoroscopy.

• Incision and Exposure: A vertical midline incision was made, and the interlaminar space at L1-L2 was carefully exposed to allow access to the underlying structures.

• Laminotomy and Ligament Removal: Laminotomy of L1-L2 was performed, followed by excision of the ligamentum flavum to fully visualize the dura and nerve roots. The nerve roots were noted to be under significant compression.

• Discectomy: The L1-L2 intervertebral disc bulge, which was calcified with extruded fragments, was removed in a piecemeal manner. Decompression was achieved until the nerve roots were lax and pulsatile.

• Closure and Hemostasis: Hemostasis was secured, and the wound was closed meticulously in layers. Standard postoperative dressing was applied, completing the procedure.

Patient postoperative care was uneventful. She was shifted to her ward four hours after surgery. Postoperatively, her pain was reduced, although weakness persisted. Physiotherapy was initiated. A gynecologist consultation was obtained for a suspected uterine mass, and further investigations were advised to be followed up later. She was discharged with instructions to continue her prescribed medications and physiotherapy.

Upon discharge, the patient’s wound was healthy, pain was reduced, and vital signs were stable. Muscle power was noted as right hip 2/5, knee 4-/5, ankle 4/5, and left hip 3/5, knee 4/5, ankle 4/5. She was prescribed medications for infection prevention, neuropathic pain management, gastric protection, anti-inflammatory and analgesic therapy, vitamin and mineral supplementation, blood pressure control, and steroid therapy for inflammation.

The patient was advised that she could take a bath and should strictly adhere to the prescribed medications and physiotherapy/rehabilitation regimen. She was also instructed to avoid any strenuous exercises.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, increasing weakness, wound discharge, or severe pain.

The patient was advised to return for a follow-up with the Neurosurgeon in Hyderabad at PACE Hospitals after 4 days. She was also advised to attend a follow-up consultation with the Gynecologist after 2 weeks.

This case highlights L1–L2 intervertebral disc prolapse with cauda equina compression managed with minimally invasive laminectomy and discectomy. Postoperative recovery was uneventful with pain reduction and a healthy wound. The patient was discharged with stable vitals, partial improvement in muscle power, and advised adherence to medications, physiotherapy, and scheduled follow-ups.