Lumbar Decompressions, Study notes of History

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Laser Spine Institute - Case Studies

Reginald Davis, M.D., FAANS, FACS – Director of Clinical Research

Lumbar

Decompressions

Physical Examination

• Spinal Exam
  • Scar: No Scar
  • Deep Tendon Reflexes: Patellar Left: 2+. Patellar Right: 2+. Achilles Left: 2+. Achilles Right: 2+.
  • Pedal Pulses: Dorsalis Pedis: 2+. Posterior Tibial: 2+.
  • LE Edema: No LE Edema
  • UE Edema: No UE Edema
  • Atrophy: No Atrophy
  • Heel Walk: Left: Normal. Right: Normal.
  • Toe Walk: Left: Normal. Right: Normal.
  • Gait: Normal.
• Spinal Exam - Sensory / Palpation Dermatomes - Left - Lumbar: Normal. - Right - Lumbar: Normal. - Spinal Tenderness - Lumbar: L1/2: No Pain. L2/3: No Pain. L3/4: No Pain. L4/5: Right. L5/S1: Right. SIJ: No Pain.

Physical Examination Continued

• Spinal Exam - Range of Motion
  • Lumbar-Thoracic: Flexion painful. Hyperextension painful. Lateral Flexion painful: Bilateral. Rotation painful: Bilateral.
• Spinal Exam - Provocative Tests
  • Cervical Tests: Clonus Test - Left: Negative. Right: Negative. Hoffman's Test - Left: Negative. Right: Negative.
  • Lumbar Tests: Babinski's Test - Left: Negative. Right: Negative. Lasegue's Test - Left: Negative. Right: Negative. Straight Leg Raise (Seated) - Left: Negative. Right: Negative.
  • Both: Romberg Test - Negative.
• Spinal Exam - Muscle Strength
  • Lumbar: Hip Abduction normal. Hip Adduction normal. Knee Flexion normal. Knee Extension normal. Gastrocnemius normal. Tibialis Anterior normal. Peroneals normal. Extensor Hallucis Longus normal.

Preoperative Images

Preoperative Images Continued

Surgery

• Patient underwent laminotomy foraminotomy decompression

on the right side at L4/

• Surgery was completed in 40 minutes
• Estimated blood loss was 10 mL
• Outcomes pending

Case Study 2 – History

• A 44 year old African American male with a BMI of 33.

presented with low back pain dating back 21 years

• CHIEF COMPLAINT: Low back pain with numbness and

burning that travels into the buttocks and leg on the right

side

• Prolonged sitting/standing, pulling, pushing, and lifting

seem to increase the pain

• Medication, ice, and heat temporarily reduce the pain
• Patient frequented a chiropractor for 18 months

Physical Examination Continued

• Spinal Exam - Sensory / Palpation

Dermatomes

• Left - Lumbar: Normal.
• Right - Lumbar: Normal.
• Spinal Tenderness
• Lumbar: Normal.
• Spinal Exam - Range of Motion
• Lumbar-Thoracic: Flexion normal. Hyperextension painful. Hyperextension limited. Lateral Flexion normal. Rotation normal.
• Spinal Exam - Provocative Tests
• Cervical Tests: Clonus Test - Left: Negative. Right: Negative.
• Lumbar Tests: Babinski's Test - Left: Negative. Right: Negative. Lasegue's Test - Left: Negative. Right: Negative. Straight Leg Raise (Seated) - Left: Negative. Right: Positive.
• Both: Romberg Test - Negative.

Preoperative Images

Discussion

What would you do?

Surgery

• Preoperative imaging confirms degenerative disc disease, disc

herniation and neural foraminal encroachment right L5/S

• Right L5/S1 laminotomy foraminotomy and decompression was

performed

• Procedure took 68 minutes to complete
• Estimated blood loss was 10 mL

Outcomes

8 1 0 1 2 3 4 5 6 7 8 9 10 Preoperative 1-Year Postoperative Pain Scale Interval

VAS

15 1 0 5 10 15 20 25 30 35 40 45 50 Preoperative 1-Year Postoperative Disability Interval

ODI

Case Study 3 - History

• A 60 year old female with a BMI of 43.55 presents with chronic lower

extremity and low back pain despite numerous attempts at conservative

care

• Pain duration of 1 year
• No prior surgery
• Pain is on both sides of the low back and extends primarily down the posterior

thighs to behind the knees

• Activities of daily living are adversely affected
• Prolonged walking/standing increases the pain while laying/sitting reduces the pain