Spinal Canal Stenosis Case Study

MRI of the lumbar spine without contrast dated 8/24/15 revealed a broad-based bulge (4mm) at L4-5, which in conjunction with facet hypertrophy and ligament flava laxity, produces mild central canal narrowing and moderate-severe bilateral neural foraminal narrowing. There is a posterior superimposed central annular fissure (7mm). At L5-S1, there is a broad-based bulge (5mm) which in conjunction with facet hypertrophy and ligament flava laxity,

My goal in solving this problem is to ensure that A.B. is healthy and comes out on top after this decision is made. Many people only see the short-term detriments to the decision, however the long-term benefits are much more important in this case. Although A.B. may not be happy when he first quits football, he eventually will come to terms with his decision, as he will live a healthy life.

A study conducted from 1997 to 2006 shows an increase of Medicare patients receiving an epidural of one hundred and two percent per 100,000 people (Manchikanti). Epidurals allow the blockade of discomfort in a specific area with an injection of an anesthetic directly into the epidural space, located along the spinal column just below the spinal cord; however, the goal of this administration route is not to eliminate total lack of feeling but to provide the patient with relief from strain so they may continue their activities of daily living. Pain, the body’s number one defense mechanism, transmits signals through nerves to the final destination of the brain. By blocking irritated nerve signals with an epidural, the mind and body can relax. Narcotics, an alternative option for uneasiness, only last for a limited amount of time and require frequent administration, while epidurals possess a longer mechanism of action and only require a one-time injection. Therefore, it remains as the primary line of method of pain alleviation for labor. Epidurals provide effective pain relief for expectant mothers without causing harm to her or the newborn baby, which has, caused a dramatic increase in the popularity of epidurals over the past decade.

In addition, CA MTUS criteria for the use of epidural steroid injections include an imaging study documenting correlating concordant nerve root pathology; and conservative treatment. As noted above, this is an appeal to the previously denied request on 02/09/16. The appeal letter states that the patient has low back pain. MRI report showed disc bulge at L5-S1 with left neural foramina narrowing. However, 01/06/16 progress report noted that there was no radiculopathy with a negative SLR on exam. The guidelines require documentation of radiculopathy on exam. In addition, there is no documentation of a trial or failure of conservative treatment, including PT, as recommended by the guidelines. Furthermore, there is no documentation of any focal neurological deficits on the exam that would indicate nerve pathology. The motor and sensory exam was normal. Medical necessity has not been established. Recommend

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.

MRI demonstrates severe narrowing of the right fouramen due to severe collapse at L5-S1. EMG demonstrates positive radiculopaty. The claimant has severe back and right leg pain. The claimant has a positive EMG. The claimant has an MRI which demonstrates up and down stenosis in the foramen at L5-S1, compressing the L5 nerve root due to severe collapse of the L5-S1 disk. The claimant has elected to proceed forward with an anterior interbody fusion at L5-S1 with an anterior decomprssion and stabilization. The claimant has severe collapse of the L5-S1 disk resulting in foraminal stenosis. The provider states a posterior decompression alone would be inadeqate given the severe collapse of the disk and the up and down

Spinal cord injuries can be extremely debilitating with significant impairment in autonomic, sensory, and motor function (Coll-Miro et al., 2016). The prevalence in Canada is on the rise with approximately 86,000 individuals suffering from such injuries as of 2010 (Noonan et al., 2012). Spinal cord injuries are generally classified as either traumatic or non-traumatic, depending on etiology (Sabapathy et al., 2015). In addition, they are subdivided into either complete or incomplete, depending on whether the spinal cord section is fully or partially damaged (Wilberger and Dupre, 2015). The latter classification has better clinical outcomes as some neurologic function is reserved (Wilberger and Dupre, 2015). Other subtypes include paraplegia and quadriplegia denoting paralysis of the lower body or all limbs, respectively (Wilberger and Dupre, 2015; Mayo Clinic Staff, 2014). The pathogenesis of spinal cord injuries is characterized by primary tissue damage due to the force of impact, followed by secondary tissue damage as a result of the inflammatory response (Sabapathy et al., 2015; Coll-Miro et al., 2015). The symptoms and severity may vary depending on the location and pathology of the contusion (Sabapathy et al., 2015). Presenting symptoms include but are not limited to numbness or pain in the extremities, loss of sensation, impaired movement or gait, abnormal reflexes, disrupted bladder or bowel function, and sexual dysfunction (Mayo Clinic Staff, 2014). Several

It seems essential that pain management as well as treatment of nausea be improved.” (Rullander, 2013, p. 58) It is well stated that pain control and nausea/vomiting needs to be controlled. There was also reference to whether PCEA which gives the patient the feeling of control. It is also shown “that the most effective analgesic method is a double epidural catheter with continuous infusion of ropivacaine.” (Rullander, 2013, p. 51). It is also mentioned that we need to take a holistic approach to treating these patients.

DOI: 11/13/2014. Patient is a 32-year old male technician who sustained injury at the time he was breaking loose a pulser component, he felt a sharp pain to his right side, low back buttocks and right leg. The patient was subsequently diagnosed with lumbar degenerative disc disease, radiculopathy and, lumbar spinal stenosis. Per MRI of lumbar spine without contrast dated 12/23/14 revealed at L4-5 there is disc space height loss, disc bulging and facet degenerative change; at L5-S1 there is posterior disc bulging resulting in mild narrowing of the central canal, and; at T11 to T12 there is posterior disc bulging resulting in mild narrowing of the central canal. As per focused history and physical dated 3/17/15, patient is presented to the office

The epidural Procedure dates back to the 19th century though rarely used due to high risk. The epidural wasn’t utilized for labor and birth pain relief until 1940 and up until the 1960’s had not gained popularity. However in the 70’s the epidural became a

Spinal cord injuries result from a fracture or dislocation of the vertebrae that is typically due to a sudden, forceful blow to the spine (“NINDS Spinal Cord Injury Information Page”, 2016). According to Early (2006), A traumatic accident, such as a shooting, stabbing, car accident, or diving accident, may result in a spinal cord injury (p. 535). According to the National Institute of Neurological Disorders and Stroke (2016), Damage to the spinal tissue results from displaced or shards of vertebral bone fragments, damaged ligaments, or discs that bruise or tear the delicate tissue and destroy axons. Destruction of axons result in the inability to carry signals from the brain and spinal cord to the rest of the body (“NINDS Spinal Cord Injury

01/06/16 Pain management Report described that the patient has a history of chronic low back pain and right lower extremity pain. The patient has a spinal cord stimulator since 01/30/15. The patient visited today for follow-up and medication refill. He reported that his pain has been stable since the last month. His pain is 5/10-scale level with the use of medications and 8/10-scale levels without the use of medication. The patient reported that the medications, activity restriction,

Spinal cord injury (SCI) is a disabling condition that makes the individual dependent on others for performing their living and professional activities (2,3). Typically, a wide range of such services are provided by a caregiver or family members and relatives of the injured person (1,3). The World Health Organization (WHO) defines caregiver as “A person who provides support and assistance, formal or informal, with various activities to persons with disabilities or long-term conditions, or persons who are elderly. This person may provide emotional or financial support, as well as hands-on help with different tasks. Care giving may also be done from long distance”.1

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.