Postlaminectomy Syndrome

HISOTRY OF PRESENT ILLNESS: This 40-year-old Latin female presents with complaints of low back and right leg pain she said that she hurt her back in a motor vehicle accident three years ago and she has had a history of intermittent low back pain since that time. Last December she started a job where she had to lift boxes that weighed approximately 40 pounds. Around the first of January this year she began to complain of back pain that

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.

Per medical report dated 01/23/15, the patient reported of middle and lower back pain and bilateral leg pain with tingling. He was diagnosed with thoracic compression fracture and lumbar spondylolisthesis.

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

Diagnosis: Other spondylosis with radiculopathy lumbar region, other spondylosis with radiculopathy lumbosacral region, Sacroiliitis, Sacrococcygeal disorders, Low back pain, other intervertebral disc displacement, lumbar region

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: 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: 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

Diagnoses include failed back surgery, lumbar; degenerative disc disease, lumbar spine; back pain; lumbar radiculopathy; spondylosis without myelopathy or radiculopathy, lumbar region; impingement syndrome of bilateral shoulders; myalgia; xerostomia; erectile dysfunction; testicular hypofunction; chronic anxiety; chronic depression; and chronic insomnia.

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

DOI: 9/4/2014. The patient is a 51-year old male paint maker who sustained a work-related injury when he missed a step on a platform and fell, jarring his back. As per OMNI entry, he was diagnosed with lumbar sprain and lumbosacral disc degeneration.

DOI: 03/11/2009. Patient is a 60-year-old male truck driver who sustained a work-related injury to his back when he tried to catch a box from falling. He is status post two back surgeries on 07/06/2009 and has reached Maximum Medical Improvement as of 06/19/2012.

In between each vertebrae of the spine lies a fibrocartilaginous cushion, known as an intervertebral disc. However, when there is an issue occurring that causes the intervertebral disc to not function properly as a cushion between the vertebras of the spine, such as intervertebral disc herniation, other complications can arise. Neck and back pain is a common issue faced by adults of various ages. Back pain is accountable for second most frequent cause for visits to the hospital, fifth most common reason for admission to the hospital, and the third most common cause of surgical procedures (Taylor, Deyo, Cherkin, & Kreuter, 1994) Intervertebral disc herniation of the spine is often the culprit of this pain. In this paper the etiology, pathology, clinical course, signs and symptoms, prognosis, occupational therapy treatment protocol, and the overall effect on the person affected by a herniated disc will be discussed.

DOI: 9/11/2001. Patient is a 47-year-old female correspondence reader who sustained a work-related injury while evacuating when she was pushed and fell in chaos due to an event. Per OMNI, she was diagnosed with herniated lumbar disc. It was noted that the patient has had

CT of the lumbar spine without contrast dated 11/3/15 revealed post-surgical changes at L4-5 and L5-S1. Overall, there is very limited examination due to patient’s body habitus, with multilevel spondylosis. Findings are most notable at L4-5 where there is bilateral neural foraminal stenosis. There is atherosclerotic disease. There are few