Facet Arthropathy Case Study

IMPRESSION: This patient has a long history of low back pain which seems to have become radicular in January of this year. She did have a CT scan that showed what appeared to be a small disk herniation at L5-S1. She also has a considerable amount of facet arthropathy. I’m not 100% certain that what we see on the CT scan is the etiology of her present symptoms. I would like to have a myelogram prior recommending surgical intervention.

MRI of the lumbar spine performed on 10/30/14 demonstrated mild anterolisthesis and prominent degenerative changes at L4-5, resulting in contact and possible impingement upon passing L5 nerve roots bilaterally. There is moderate bilateral facet arthropathy at this level. Mild central canal narrowing is seen at L4-5. Mild chronic compression deformity, superior endplate of T12 is seen.

Based on the latest medical report dated 04/08/16, the patient presents for follow-up of his lower back pain. He is status post radiofrequency facet on the left that initially helped with left sided lower back to 60%. He stated that PT was stopped by insurance for the past 2 weeks. Since he started PT, he has been having increased spasm across his lower back with pain into the left lower extremity. IW feels that PT

Physical therapy saw the patient, and the result of the examination are as follows; 6/10 left knee pain at rest and during activity (0 no pain, 10 worst pain), manual muscle testing for both upper and lower extremities were 4/5 except left knee flexion/extension 3+/5 due to pain, sensation on both UE/LE were intact to light touch, Stephen requires a moderate assistance of one person for both functional mobility and gait activity. He uses a front wheeled walker up to 35 feet due to decreased balance and antalgic gait from the left knee

He still does have significant amount of residual back pain. Also, he does get still intermittent pain and numbness in the legs, left side worse than the right side. He also gets bilateral knee pain. He continues to have some bladder incontinence episode urgency. He does feel depressed as well. Treatments to date include anti-inflammatory medications, physical therapy, epidural injection performed in May 2015, spinal surgery in 2011, L4-L5 laminotomy with good improvement, and left L5-S1 laminotomy on 4/20/16 with improvement postoperative. Physical examination revealed that the patient has been able to discontinue the use of cane. There is pain to palpation over the L5-S1 area. Range of motion is limited. The patient has flexion of 60% of normal and extension of 40% of normal. Motor strength is 5-/5 in the left lower extremity, especially in the gastrocsoleus and extensor hallucis longus. Sensation is slightly diminished in the L5 distribution bilaterally, left worse than the right. Deep tendon reflexes is 2+ at the bilateral knee and 1 + at the bilateral ankle. Plan notes physical therapy of 2 x/ week to strengthen muscles, stabilize the spine and reduce pain; Flector patch 1.3% to be applied one patch to the back every 12 hours as necessary for

MRI of the cervical spine dated 08/17/16 showed at C3-4 and C4-5, there is mild posterior disc bulging.

11/13/14 MRI of the lumbar spine showed 4mm left paracentral and foraminal disc protrusion at L4-5, which mildly impinges upon the thecal sac and the proximal left L5 nerve root. The disc protrusion also moderately narrows the left foramen and lateral recess. There was also a 2mm posterior central disc protrusion at L5-S1. A 2mm disc bulge at L2-3 was seen. There was a mild degenerative facet and ligament flava hypertrophy at L4-5 and

Per the medical report dated 08/12/16 by Dr. Gunderson, the patient had neck pain, as well as headaches, dizziness and blurred vision. The neck pain radiated into both shoulders, but more so on the right, and occasionally she had tingling in her upper extremities. She described the neck pain as severe and intermittent, and not related to any specific activity, and relieved with massage. The pain in her lower back was in the beltline and radiated into both lower extremities, more so on the left. She described the pain as moderately severe and constant, and not related to any activity, and only relieved with nerve medicines. On examination, the patient had tenderness in the lower cervical region about C5 to C7. Range of motion of her neck was 75% of normal. Motor, sensory, and reflex examinations in the upper extremities were normal. On examination of the lumbar spine, the patient could dress and undress without difficulty. She had a bent forward posture and gait. She had reduced lumbar motion and with maximum forward flexion, her fingertips were 12 inches from the floor. Lateral flexion was 50% of normal, and she had no active extension in the lumbar spine. Motor, sensory, and reflex examinations in the lower extremities were normal. There was paravertebral tenderness about L4-5 bilaterally, as well as in both sacroiliac and sciatic notch regions. Straight leg caused hip and thigh pain at 50 degrees bilaterally. Of note, X-rays of the cervical spine demonstrated disc degeneration at C5-6. X-rays of the lumbar spine were normal. Patient sustained

He reports no major changes in his condition, since his last visit. His pain is rated as 3-6/10, described as dull, hard, aching or worse. Pain is increased with sitting, standing, walking, lifting, looking up and down, turning to the sides, bending, and twisting. He is unable to work. He is very limited physically. He has to modify or avoid social and recreational activities to manage the pain. He feels like his quality of life is severely affected. His pain is 80% in the neck and 20% in the upper extremities, mostly on the

An MRI of the lumbar spine dated 03/23/17 revealed broad-based central 4 mm subligamentous disc protrusion and annular tear at L4-L5. There was a 2.7 mm subligamentous disc protrusion centrally at L5-S1. Neither of these two levels demonstrated compressive discopathy, central canal stenosis or foraminal impingement. There was a mild straightening of the normal lumbar

DOI: 11/13/2014. Patient is a 32-year old male technician who sustained injury at the time he was breaking loose a pulser component, he felt a sharp pain to his right side, low back buttocks and right leg. The patient was subsequently diagnosed with lumbar degenerative disc disease, radiculopathy and, lumbar spinal stenosis. Per MRI of lumbar spine without contrast dated 12/23/14 revealed at L4-5 there is disc space height loss, disc bulging and facet degenerative change; at L5-S1 there is posterior disc bulging resulting in mild narrowing of the central canal, and; at T11 to T12 there is posterior disc bulging resulting in mild narrowing of the central canal. As per focused history and physical dated 3/17/15, patient is presented to the office

MRI of the lumbar spine was obtained on 05/22/14 which revealed status post posterior surgical fusion of L4, L5 and S1 with no evidence of recurrent/residual disc herniation. There is a mild disc bulge at T11-12, L2-3 and L3-4 levels.

Lumbar Disc Herniation is one of the commonest problems in adults. At their productive age this problem is debilitating and if timely intervention is not made the outcome is quiet disabling. Lumbar disc herniation in the past have been treated successfully with both conservative and surgical modalities. Various studies in the past have proved both these modalities, conservative and surgical treatment to give a good relief of symptoms.

DOI: 09/13/2006. Patient is a 40-year-old male traffic control technician who sustained a work-related injury to his back from lifting arrow board trailer. Per OMNI, he was diagnosed with lumbar herniate d nucleus pulposus. Patient was deemed maximum medical improvement (MMI) on 09/22/08 at maximum medical improvement (MMI) with 18% permanent disability. Future medical care include orthopedic visits, PT, gym membership, MRI, Epidural Steroid Injection (ESI) and back surgery.

Facet joint syndrome is a common disabling condition. Degeneration of the motion segment leads to a loss of height of the segment resulting in an athrosis of the facet joint. The degenerative changes in the joint result finally in a chronic inflammatory process. Injection of corticosteroids and oral pain medication are of little value in the long-term treatment. Advances in regenerative medicine revealed immune-modulatory properties of stem cells.