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L5-S1 Discectomy Case Studies

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DOI: 7/2/2010. The patient is a 57-year-old female claims examiner who sustained work-related injuries to her bilateral knees, low back, psyche, cervical, shoulder and left hip while packing contents of desk.
According to the AME report on 4/2/12, the IW’s continuing treatment should include occasional doctor visits, prescription medication, sacroiliac injections, trunk exercises, access to pool and land based therapy. The examiner also notes that the IW should probably continue with psychotherapy.
Per progress report dated 01/05/16, the IW reports ongoing neck and low back pain, with numbness in her left fingers.
Based on the progress report dated 02/02/16, the IW reports ongoing neck and low back pain, with numbness in her left fingers.
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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.
On examination of the lumbosacral spine, there is tenderness to palpation of the paraspinals and L3-4 facets and left sacroiliac joint. Pain is made worst with extension and lateral bend.
The patient has clear sacroiliac sulcus tenderness with direct palpation. Pain is reproduced with provocative testing, most prominent with hip flexion/abduction while externally rotated. Patrick’s/Faber’s test, pelvic thrust test, Gaenslen’s test with the patient supine, and Sacral Compression/Yeoman’s test while prone are positive. Spasm is noted at the bilaterally. Strength is decreased at the left lower extremity. Sensation to pin is decreased at left L3, L4, L5, S1 and left T1.
Current medications include Percocet, Restoril,
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