Timely neurosurgical intervention saves UAE patient from permanent disability

Doctor says it is important not to ignore severe back pains

A 54-year-old male Pakistani patient diagnosed with Acute Lumbar Disc Prolapse was saved by a timely neurosurgical procedure at a hospital in Ajman.

The procedure, performed by Dr. Ishwar Chandra Premsagar, Consultant – Neurosurgery at Thumbay Hospital Ajman – was a high-risk operation which led to the complete recovery of the patient.

The patient was having a previous history of backache since 3-4 years, but he never took it seriously. He had undergone MRI previously and had been advised surgery, but he was scared of undergoing a surgical procedure on his spine.

One morning, he visited a neurosurgeon at a hospital in Sharjah, complaining of severe back pain since three continuous days.

Never ignore severe back pains

Not only had his back pain become unbearable, but he was unable to walk and also had incontinence; his body was unable to control urination/defecation. The neurosurgeon examined him and referred him to the hospital in Ajman, recommending immediate surgical intervention.

After examining the patient, the doctor did an MRI on the patient and found Acute Lumbar Disc Prolapse, a condition where one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.

The situation was so critical that if the surgery was delayed any further, the patient would have been in the risk of permanent incontinence and impotence, with the chance of remaining paralysed for the rest of his life. So, the doctor immediately prepared for surgical intervention, confident that recovery was possible.

The operation was performed and the prolapsed disc piece was removed. After the surgery, he was transferred to the ICU, considering that he had earlier undergone cardiac procedure in Pakistan about eight years ago, as well as on account of his being pre-diabetic.

He was also on Disprin, a blood thinner. Since the effect of Disprin takes about a week to wear off completely, the urgent surgical intervention necessitated by the patient’s condition was in the high-risk category, and a consent was signed by the patient before the procedure.

The surgery was performed in the evening, and at night when the doctor visited him, the patient said that the numbness in his perineal area had greatly subsided, and that he felt back to normal. The doctors had also not inserted urinary catheter during surgery, due to his pre-diabetic condition, to avoid the risk of urinary infection.

The next morning, he passed urine on his own, and told the visiting doctor that he was now in control of his excretory functions.

“The procedure was very successful, by God’s Grace, and this sort of recovery is not very common,” said Dr. Ishwar Premsagar, a day after the surgery.

“Acute Lumbar Disc Prolapse is a condition where the disc presses against the nerves, disabling them, as a result of which the patient experiences numbness. Prolonging this condition can damage the nerves permanently, leading to irreversible paralysis,” he added.

He also said that a patient with this condition required urgent surgical intervention, for better chance of recovery.

The procedure performed, “fenestration of the lamina” was done in such a way that unlike the usual way, in this case very little bone was removed, leaving the spine totally intact; meaning that the patient - a truck driver, will be able to return to work.

This condition is more common among people who do heavy work, although people of all profiles, irrespective of gender and age can be affected by it, according to Dr. Ishwar Premsagar.

It is important not to ignore severe back pains, he stressed.

“Had the patient come in earlier, we could have cured him by a simpler endoscopic surgery, instead of making a bigger incision,” he added.

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