| Multi-Specialty
Case Reviews: Post-laminectomy Syndrome |
Post-laminectomy syndrome: surgeon viewpoint
Since the patient’s symptoms have been long standing
and he has tried conservative treatment he would be a
reasonable candidate for surgery. Factors that suggest
he would do well with a fusion include the fact that there
is a lot of disc space collapse at L5-S1 and that the
rest of the discs are all well preserved.
As the disc space collapses the nerve root exiting
the level (in this case the L5 nerve) can get irritated
and radiate pain down the leg. He does not have a recurrent
disc herniation so a discectomy alone will not provide
him any relief.
Because there is a lot of disc space collapse and the
exiting nerve root is affected, an anterior approach
to "jack open" the disc space would be best.
A posterior approach for the surgery would not allow
as much disc space distraction. Fusing the disc space
would not only help relieve pressure on the nerve, but
also would fuse the severely degenerated disc space
and help relieve his chronic low back pain. With the
interbody fusion either a cage or bone dowels could
be used to keep the disc space distracted while it is
fusing (the surgeon will choose the method he prefers).
Of course, the patient's other option would be to continue
to live with his discomfort and try to manage his pain
as best as possible with conservative treatment. He
is otherwise neurologically intact and is not in any
danger if he does not have the surgery.
By:
Peter F. Ullrich, Jr., MD
December 14, 2000
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