| Multi-Specialty
Case Reviews: Post-laminectomy Syndrome |
Post-laminectomy syndrome: chiropractor viewpoint
The patient is suffering symptomatically and beginning
to be further restricted functionally but the nerve roots
do not seem to be in peril at this time. He has back and
leg pain, settling of the facets with the disc narrowing
and significant degenerative disease. A lot of information
is lacking. What is the type of conservative care he has
received? Can the pain generator be more clearly delineated
diagnostically?
With pain on flexion and extension an examination of
facet joint function is in order. If provocative movement
and pressure to the facet joints evokes the patient’s
pain and there is evidence of local joint restriction,
then a trial of continuous passive motion and high velocity,
low amplitude (HVLA) spinal manipulation may prove useful.
If manipulation has been a part of the earlier conservative
care or symptom relief is only temporary but facet disease
seems clinically evident, then facet injection followed
during the analgesic period (manipulation under joint
analgesia) may provide more long term relief by permitting
more complete mobilization of the joint.
Degenerative disease with disc settling increases stress
in the facet articulations. Clinical experience and
research including cohorts with chronic pain suggest
that painful articulations benefit from increased movement.
Biomechanically, continuous passive motion and HVLA
has been shown to decrease pain and increase function.
The individualistic patient response and the extent
of pathology will limit the final outcome. State of
the art requires an appropriate trial (2 to 4 weeks)
of therapy to determine the prognosis.
By:
John J. Triano, DC, PhD
December 14, 2000
|
|
