CLINICAL PICTURE: A 55-year-old man presented with intermittent low back pain which was progressively worsening, fever, anorexia, low back pain and a 10-kg weight loss. He had underlying diabetes mellitus and ischaemic heart disease. He gave a history of travel to caves for worship. Clinically, the most significant findings included nodular lesions in the anterior fauces and left palatoglossal region. Computed tomographic scan revealed bilateral adrenal masses. Biopsies were taken from the palatal nodules, which revealed histiocytes with numerous histoplasma organisms.
TREATMENT: He was commenced on itraconazole 200 mg daily for a period of 9 months. There was a dramatic initial response with settling of his fever and this was followed by subjective improvement in his well-being.
OUTCOME: He is presently on follow-up and has completed 9 months of itraconazole therapy with resolution of all his symptoms and has gained about 10 kg of weight.
RESULTS: There were 27 patients with 30 segments of surgery. They were 12 males and 15 females with an average age of 58.81±8.1. There was significant improvement in VAS for lower back pain from 7.11±1.31 to 3.67±1.3, VAS for leg pain from 6.81±2.19 to 1.59±1.89, ODI from 26.41±8.95 to 13.69±8.34, and JOA score from 7.63±2.87 to 13.5±1.73. A-P diameter increased 134%, lateral diameter increased 120%, lateral recess depth increased 166%, disc height increased 126%, foraminal height increased 124%, spinal canal area increased 30%. The p-values were all <0.001. The average hospital stay was 6.79±3.01 days. Complications included 1 pedicle screw malformation, 1 ALL avulsion fracture, 1 abdominal herniation, 1 venous damage, 1 failure.
CONCLUSION: XLIF surgery presents a favorable option for patients with lumbar spinal stenosis. This is a minimally invasive surgical method that reduces pain, reduces bleeding, and is effective in indirectly decompressing the spinal canal both clinal and imaging.