Cervical Discectomy Case Study

MRI demonstrates severe narrowing of the right fouramen due to severe collapse at L5-S1. EMG demonstrates positive radiculopaty. The claimant has severe back and right leg pain. The claimant has a positive EMG. The claimant has an MRI which demonstrates up and down stenosis in the foramen at L5-S1, compressing the L5 nerve root due to severe collapse of the L5-S1 disk. The claimant has elected to proceed forward with an anterior interbody fusion at L5-S1 with an anterior decomprssion and stabilization. The claimant has severe collapse of the L5-S1 disk resulting in foraminal stenosis. The provider states a posterior decompression alone would be inadeqate given the severe collapse of the disk and the up and down

DOI: 9/30/2011. Patient is a 41-year-old male information technology computer support specialist who sustained injury while he was walking through a lobby when he slipped and fell. Per OMNI, he was initially diagnosed with lumbar intervertebral disc syndrome, myofasciitis and right arm strain. He underwent a right shoulder surgery on 07/16/13 and 12/22/15.

DOI: 8/24/2008. Patient is a 55-year-old female manager who sustained injury to her neck and back when she slipped and fell while walking down a set of pull out stairs. Per OMNI, she is diagnosed with cervical strain with radiculopathy and lumbar radiculopathy. She underwent C5-6 partial corpectomy and fusion in 05/31/2011.

Of note, previous x-rays of the lumbar spine dated 01/14/16 showed a solid fusion at L4-5 with interbody graft at L4-5 as well as pedicle screw fixation in satisfactory alignment.

On the statement of medical necessity per MG-2 form dated 07/13/16, patient has been experiencing severe lumbar spine pain/spasms since the injury. She complains of lumbar spine pain with cramps in the lower extremity going down to the feet, associated with tingling sensation. There is left greater than right L3-S1 pain and spasms, left greater than the right L3-4, L4-5 and L5-S1 facet joint pain, upon posterolateral extension at 45 degrees. There is bilateral sacroiliac joint tenderness. There is tenderness over the right lateral quadriceps muscle. Range of motion (ROM) is limited secondary to

Per PT note dated 05/09/14, the patient has had 36 post-operative PT sessions for the back.

DOI: 4/26/2006. Patient is a 51-year-old male chief engineer who sustained a low back injury when he was using a snap pipe cutter and felt low back pain. Per OMNI, he underwent an L4-5 right redo hemilaminotomy and discectomy on 05/07/2007 and an L4-L5 posterior spinal fusion with instrumentation and an L4-L5 transverse lumbar interbody fusion with a cage on 8/29/2011.

Based on the progress report dated 03/28/16, the patient complains of pain to his lumbar

In September of 2010, I was diagnosed with sever degenerative disc disease, with a prognosis of possible paralysis within 6 months. Considering the severity of my condition and the complexity of the surgery, I was referred to Dr. Herzog. Because of the urgency of my situation, my surgery was scheduled and, on October 12, 2010, Dr. Herzog performed an anterior cervical discectomy fusion involving

DOI: 10/6/2015. Patient is a 40-year-old right hand dominant female production employee who sustained a work-related injury to her neck, left shoulder and right hand from packaging work.

Diagnoses are cervical radiculopathy, right shoulder pain, nondisplaced fracture of the greater tuberosity of the right humerus and right shoulder bursitis. He has reached maximal recovery for his right shoulder. MD is concerned that the elbow and hand pain are related more to his neck as he has a history of cervical radiculopathy and his symptoms are more of tightness than pain that can be localized. He has had epidural injections in the past for left sided radiculopathy. An updated MRI is requested. If there are right-sided findings, he will be sent for possible injection for the upper extremity pain. Otherwise, he will be sent for a second opinion for his continued

01/15/16 Progress Report noted that the patient has lower back pain and left leg pain. It was noted that the provider spoke with the patient over the phone. He has continuing pain in the right lower extremity. The epidural injections have been denied. He has a herniated disc on the right L2-3. He has been suffering from symptoms in the right leg for the last 5 months. He cannot tolerate the pain. He would like to pursue surgery. The examination of the thoracic spine was normal. The exam of the lumbosacral spine showed that all musculature

12/2/15 orthopedic report identified neck and upper back pain that radiates to the arms, worse on the right. There is loss of grip strength and weakness in both hands and arms, primarily the right. There is a burning sensation in the arms. Exam revealed atrophy in the intrinsic muscles of both hands. There is no hyperreflexia. The patient has poor gait and wears a neck brace. He has difficulty toe walking and heel walking. The physician recommended pain management at this time. The physical exam revealed limited ROM at the cervicothoracic junction. Current medications were not documented. Treatment plan included Vista collar, medications, and revision surgery: cervical osteotomy in order to realign his spine with augmented fusion more likely to the base of the skull.

Treatment plan includes new MRI of the lumbar spine with 3.0 Tesla, EMG/NCV of the bilateral lower extremities and Xrays of the lumbar spine with anteroposterior, lateral and flexion/extension views.

Interventional care has included nerve blocks/injections, epidural steroid injections, and lumbar radiofrequency ablation. The patient obtained more than 80-90% pain relief and functional improvement with decreased medication requirements lasting more than 1 year from left radiofrequency ablation (RFA) in 2013 per Dr. Kenly. She also has had bilateral sacroiliac joint injections with good relief, the last being in 2013. The patient obtained more than 75% pain relief and functional improvement with decreased medication requirements lasting more than 3 weeks from lumbar facet injection on 1/14/16.