Linear Facet Arthropathy: A Case Study

DOI: 2/8/2016. Patient is a 54-year old male laborer who sustained a work related injury/ fractured 3 ribs & back when he got stuck and fell on his left side against the concrete when he was operating jack hammer. The patient is subsequently diagnosed with Herniation of lumbar disc. As per workers’ compensation follow up dated 7/25/16, patient complains of low back and radiating pain. In the evaluation there was an S1 distribution with weakness that was quite significant. Of note, the test of the MRI scan revealed that L5/S1 had a broad-based disc bulge of 3.5 mm, bilateral facet arthropathy, and at L4/5 there is also a broad-based concentric bulge. Physical examination revealed that he is still having pain in the back going down into the buttock. It is not an acute radicular event.

MRI of the lumbar spine on 1/14/2016 revealed chronic appearing bilateral L5 pars interarticularis fractures, grade II spondylolisthesis, a large diffuse broad-based disc herniation which is greater on the left with large far lateral disc bulge components at L5-S1 with moderate to marked bilateral lateral recess stenosis, marked bilateral neural foraminal stenosis and compression of the foramina aspects of both exiting nerve roots.

MRI of the lumbar spine dated 07/24/15 showed degenerated L4-L5 disc. There is a significant foraminal narrowing at L4-L5 on the left with effacement of the left L4 nerve root.

DOI: 7/29/2005. Patient is a 62-year-old female home attendant who sustained injury when the vehicle she is in made a sharp turn and she fell out of her seat.

01/08/16 Progress Report noted that the patient sustained an initial injury in June 2014, due to a cumulative trauma. She sustained a new injury in January 2015 as well. She sustained an injury to her neck, right shoulder, right arm, and right knee. She had X-rays and MRI post injury. Her right knee swelled, but improved right after she received treatment for her right shoulder and right knee. She received PT and chiropractic treatment twice a week, medications and surgery to her right shoulder in May 2015. She has received no treatment for her neck or left shoulder. She has not received acupuncture. The patient presented today with complaints of occasional, mild to moderate, throbbing neck pain, stiffness and cramping. The physical exam of the cervical spine revealed positive tenderness to palpation of the cervical paravertebral muscles and bilateral trapezii. There is also a muscle spasm of the cervical paravertebral muscles. The cervical ROM is decreased and painful. Shoulder depression causes pain. The exam of the thoracic spine showed tenderness to palpation of the thoracic paravertebral muscles, right trapezius, T1-T2 spinous process, T2-T3 spinous process, right Rhomboid and right lateral

The latest progress report noted that the patient has neck and low back pain rated 7/10. The Physical exam revealed restricted ROM in the lumbar spine. TTP and

DOI: 3/8/2011. Patient is a 49-year-old male route sales representative who sustained cumulative trauma to his neck, psyche, back, abdomen and lower extremity. Per OMNI entry, IW is initially diagnosed with chronic cervical and lower back pain with radicular symptoms, and chronic knee pain. Per the AME supplemental report dated 10/11/13 by Dr. Abeliuk, future medical care includes cervical and lumbar ESI, nonsteroidal anti-inflammatory drugs (NSAIDS), non-narcotic analgesics and access to 24 PT visits in two years, for flare-ups.

Based on the progress report dated 08/25/16 by Dr. Ahmed, the patient complains of left shoulder pain, neck pain, low back pain, and right ankle pain. IW have received certification for 12 visits of physical therapy to the lumbar spine and right ankle. Overall, the pain and symptoms remain the same. Patient also complains of difficulty sleeping due to

DOI: 12/7/2006. Patient is a 66-year-old male truck driver who sustained back pain due to years of work. Per OMNI, patient is a status post decompressive laminectomy on 8/20/09 and fusion on 10/21/10. He also had a left total knee replacement.

12/07/15 Progress Report described a follow-up visit. The patient continued to report adequate pain with the use of Vicodin and Flexeril. Review of utilization review report indicated that these medications were no longer certified. However, TPI trial with anesthetic has been certified. The patient noted 5/10-scale level pain in the lumbar region without radiation. He denied any side effects of the medication. Examination revealed trigger points with a jump response on palpation of the lumbar paraspinal muscles. The ROM is restricted in the lumbar region secondary topain and stiffness. Faber sign is positive on the left. SI joints are non-tender. SLR and sitting SLR are negative. Treatment plan included Vicodin and Flexeril. Work status: Return to full duty; avoid lifting > 20 lbs and frequent bending activities.

Per AME report dated 5/5/2014, future medical treatment should include MRI of the right hip and lumbar spine, EMG and nerve conduction study, use of oral and topical analgesics and home stretching exercise program. Per the supplemental report dated 9/19/2014, patient was declared permanent and stationary. Attached is another Supplemental to the AME report dated 03/11/15.

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.

DOI: 2/10/2013. Patient is a 55-year-old female nurse assistant who sustained injury to her lower back from lifting a patient.

MRI of the lumbar spine without contrast dated 5/22/14 revealed degenerative disc disease at L3-4 through L5-S1; large central and right paracentral disc herniation and extruded disc at L4-5; there is severe stenosis of the right neural foramen at L4-5 entrapping the right L4 nerve; and severe right and left neural foraminal stenosis at L5-S1 entrapping the right and left L5 nerves.

01/27/16 Progress Report noted a follow-up visit. The patient continues to have right shoulder pain. The last injection helped him a lot. He also complains of horrible lower back pain. The patient states that the pain is so sharp that sometimes he cannot even sleep due to the pain. The exam of the right shoulder showed no TTP. The ROM was full. Neer’s and Hawkin’s tests were positive. The exam of the lumbar spine revealed a slight antalgic gait. He is slightly limping and uses a cane. There was exquisite tenderness noted throughout the lumbar paravertebrals worse at L5-S1.