Intractable Spine Pain Syndrome: Case Study

Low Back: Article by Fritz and Kelly demonstrated literature review of how to differentiate low back pain between musculoskeletal and non-musculoskeletal sources. The patient demonstrated with red flag signs and symptoms that lead the therapists to believe it could be a non-musculoskeletal problem. They discovered that bilateral leg symptoms and spinal deformity is a possible indication of spinal neoplasm. The patient presented with both of these symptoms along with insidious onset of pain. A clinical decision was made to refer the patient to receive an MRI. The MRI ruled out a spinal neoplasm, but did show a grade 2 spondylothesis.

A visit note from Gregory Carico, MD (Internal Medicine), dated 01/23/2017, indicated that the claimant presented with a history of depression. She was involved in a motor vehicle accident on December 9th. She was relieved from work duties from 12/09 to 01/04 and was able to return to work on 01/10. She was again off work on 01/12 for therapy. She had pain in the thoracic part of the back and lower neck to middle back. She was diagnosed with a sprain of ligaments of the thoracic spine. An

DOI: 09/12/2014. Patient is a 45-year-old male vacation relief route sales representative who sustained a work-related injury to his lumbar spine from bending and pulling a bread product. Per OMNI entry, he was initially diagnosed with disc herniation at L4 to L5 with radiculopathy. He is status post extraforaminal L4 to L5 discectomy on 04/09/2015. He has been off work for nearly 2 years.

DOI: 7/7/2015. The patient is a 48-year-old male cleaner who sustained a work-related injury to his back while moving a heavy bookcase. As per OMNI, the patient was diagnosed with lumbar degeneration, thoracic or lumbosacral neuritis and myofascial pain.

DOI: 12/5/2013. The patient is a 57-year-old female precertification technician who sustained a work-related injury to her head, neck, lumbar spine, and right knee after slipping and falling on icy sidewalk. As per OMNI entry, she was diagnosed with head/scalp injury, status post concussion, cervical strain, headaches, and right knee medial meniscal tear status post surgery on 06/04/2014.

Per the medical report dated 07/18/16, patient is being seen for her lower backache, rated 7/10 with medications and 10/10 without medications. Current medications include Ambien 10mg; Maxalt-MLT 10mg; Norco 10/325mg; Evzio 0.4mg; orphenadrine 100 mg and gabapentin 600 mg.

DOI: 11/5/2004. Patient is a 58-year-old male pitcher driller who sustained a work-related injury to his low back when he slipped and fell backwards while cleaning a tub with a shovel. As per OMNI entry, the patient underwent laminectomy with decompression at L3-4 and L4-5 with degenerative disc disease and spondylolisthesis at L5-S1 on 07/14/2005; however, the surgery failed.

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.

IW was diagnosed with sprain of the ligaments of the cervical spine. Patient has received chiropractic care. Response has been good and IW is encouraged with gains being made. Improved function and functional restoration are expected with additional treatments. Plan is for chiropractic treatment, 2 times a week for 3 weeks.

DOI: 9/30/1997. The patient is a 50-year-old female reservation clerk who sustained a work-related injury to her back and bilateral lower extremities when she tripped and fell.

This is a 51-year-old female with an 11/4/2013 date of injury, when she slipped and fell on a wet floor landing on her buttocks.

Some effects of this disease includes axial muscle weakness, crooked spine as well as respiratory insufficiency

DOI: 9/19/2012. Patient is a 50-year-old female route sales representative who sustained a work-related injury when she was involved in a rear end collision. Per OMNI, she suffered injuries to her neck, right shoulder, back, and vertigo. She has attended PT, chiropractic therapy and balance therapy.

Patient is diagnosed with lumbar arthrodesis and bilateral sacroiliac joint dysfunction. She is status post bilateral sacroiliac joint arthrodesis with X-spine instrumentation in 06/08/2015.

While the etiology of adolescent idiopathic scoliosis is unknown, a genetic contribution is suspected (8). Twin and family history studies have shown that familial adolescent idiopathic scoliosis may possibly be linked to the X-chromosome and have a dominant pattern of inheritance (9). Other factors such as growth hormone secretion, paraspinal musculature, connective tissue structure, vestibular function, and melatonin secretion may each collectively play a role in the etiology of idiopathic scoliosis (2). No clear evidence supports any one factor plays a dominant role in the pathophysiology of the condition (2).