Lumbar Fusion Case Study

Spinal fusion is categorized into three different categories: cervical, thoracic, and lumbar, in conjunction with the different segments of the spine. Each type of spinal fusion has a different goal depending on the purpose of the surgery. Most surgeries involve fusing vertebrae together to limit its range of motion, thereby hopefully reducing the pain or correcting any physical deformities. Depending on the levels of fusion, spinal fusion surgeries tend to last a few hours. Complications may arise during surgery, and they greatly increase depending the location of the fusion, levels of fusion, and if the surgery crosses any important nerve sites. Levels of spinal fusion are known as the fusion between two different vertebrae. If there is a fusion between L1 and L2, that is known as one level of fusion. If there is another site of fusion at L3 and L4, than there will be two levels of spinal fusion. Lumbar fusion are further complicated when more then one level of performed. By limiting one segment’s range of motion, other segments of the spine will have to compensate and create greater range of motion. With lumbar fusion, most doctors will need to be able to identify why a patient needs lumbar fusion, and being able to identify if lumbar fusion will help alleviate the pain. Most cases of lumbar fusion involve spondylolisthesis, fractures, spinal stenosis, scoliosis, and possibly herniated disk if no other further treatment has proven successful. Most physicians will order an

MRI of the lumbar spine obtained on 05/19/15 revealed at L2-3, endplate osteophyte formation and disc bulge contribute to a mild degree of spinal canal stenosis and a mild degree of bilateral neural foraminal compromise. At L3-4, a disc bulge eccentric leftward and endplate osteophytes formation are responsible for a mild degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a moderate degree of left neural foraminal encroachment. At L4-5, there is a diffuse disc bulge and endplate osteophyte formation which effaces the ventral aspects of the thecal sac and are responsible for a moderate-to-severe degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a severe degree of left neural foraminal encroachment. At L5-S1, a shallow disc bulge and endplate osteophyte formation contribute to a mild degree of left neural foraminal encroachment, without compromise of the spinal

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.

MRI of the cervical spine obtained on 06/26/13 showed mild degenerative spondylitic changes and status post posterior fusion.

Assessments are lumbosacral intervertebral disc disorder with radiculopathy, lumbar spondylosis without myelopathy or radiculopathy and myalgia.

MRI of the lumbar spine obtained on 12/21/11 showed at L4-5 level, there is some mild loss of normal hydration of this nucleus pulposus representing early dessication changes, with a minor 2-3 mm subligamentous posterior disk bulge/protrusion slightly elevating the posterior longitudinal ligament indenting the thecal sac without spinal stenosis and neuroforaminal narrowing.

DOI: 06/23/2011. This is a case of 41-year-old male maintenance worker who sustained injury to the low back while taking off a sliding door of a patio. As per OMNI notes, patient is diagnosed with lumbar disc disorder with myelopathy. MRI of the lumbar spine dated 6/28/15 revealed recurrent left paramedian L4-5 disc herniation with caudal extrusion of a 10 mm fragment into the left L5 lateral recess. As per office notes dated 7/25/16, the patient is status post redo left L5-S1 discectomy performed on 4/20/16. It was also noted that the patient had a prior L5 laminotomy several years ago. He subsequently did well. However, he had recurrence of his pain. Pain is radiating into his left leg worse on the right leg. This was unresponsive to conservative

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

MRI of the lumbar spine dated 07/30/15 demonstrated interval post-surgical change with removal of the disc extrusion at L4-5. There is residual granulation tissue versus broad-based left paracentral disc protrusion with left lateral recess stenosis.

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.

Spinal fusion is a procedure to make 2 or more of the bones in your spinal column (vertebrae) grow together (fuse). This procedure stops movement between the vertebrae and can relieve pain and prevent deformity.

DOI: 6/26/2002. The patient is a 64 -year-old female patrol officer who sustained a work-related injury to her back, shoulder and legs due to constant driving at work. As per OMNI, the patient is status post lumbar surgery on 1/13/11 and epidural steroid injection on 9/24/12. MRI of lumbar spine with and without contrast dated 6/6/12 revealed congenitally shortened pedicales at the L1-L2 level but no impingement on the thecal sac or nerve roots at this level is identified; desiccated L2-L3 disc with bilateral facet joint arthropathy resulting in moderate bilateral neural foraminal stenosis but no impingement on the thecal sac or nerve roots at this level is identified; desiccated L3-L4 disc with bilateral facet joint arthropathy resulting in moderate bilateral neural foraminal stenosis but no impingement on the thecal sac or nerve roots at this level is identified;

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

However, there is no abnormal cord signal.There is a moderate to severe multilevel bilateral neural foraminal stenosis, predominantly due to uncovertebral joint degeneration, most severe on the right at C6-7. Cervical kyphosis and mild cervicothoracic dextroscoliosis are seen. Multilevel degenerative disc disease is noted, most significant at C4-5.