| Multi-Specialty
Case Reviews: Post-laminectomy Syndrome |
Post-laminectomy syndrome
History of present illness
The patient is a 47-year-old male who had an L5-S1 discectomy
5 years ago. Although the back surgery relieved his sharp
leg pain, he continued to not only have back pain but
also leg pain.
Over the years he has had extensive conservative treatment,
which allowed him to control his back pain and leg pain
and also to continue to stay functional. He is still
working although with some restrictions, and this is
considered a work-related injury. In the past year,
he has missed more work and it is getting increasingly
difficult for him to function at work within his current
restrictions. The pain is worst when he is sitting,
although he also cannot walk for long distances anymore.
He is otherwise healthy and does not smoke.
Physical exam
On physical exam he has forward bending to his kneecaps
only, and very limited extension. His reflexes are intact
and symmetrical, and he has normal strength in all his
muscle groups. He has a positive straight leg test on
the left. He does not demonstrate any pain behavior
and is otherwise easy to examine.
Imaging studies
MRI scans show severe degeneration at the L5-S1 level
and no other levels of degeneration. There is a large
anterior osteophyte (bone spur). There is a lot of disc
space collapse present at the L5-S1 disc. The axial
scan shows scar tissue around the L5 nerve root, but
no evidence of a recurrent disc herniation.
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