Post on 15-Apr-2017
Failed Lumbar Laminectomy
• Upper Chesapeake Medical Center• Bel Air, Md• April 1, 2016
68 year old man with a cc: R lower extremity pain
HPI: S/P L2L4 laminectomy 2014 with 3 months of pain relief, but
symptoms returned. Terrible pain in the R
lateral and anterior thigh keeping the hip flexed/
cannot walk for two weeks due to pain and weakness. cannot walk
with walker 3/4/16, seen in ER 3/6/16
PMH: IDDM, Crohns,
Exam: 5’8” 270R quad 1/5, R hip flex 1/5,
ankle DF 2/5
Kleeman, T.J., Hiscoe, A.C., Berg, E.E.: “Patient Outcomes Following Minimally DestabilizingLumbar Stenosis Decompression: The ‘Port Hole’ Technique”, Spine, April 2000.
ULBD
laminectomy
Porthole/interlaminar fenestration
ER visit for terrible leg pain 3/6/16
PAIN SO SEVERETHAT HE CANNOTGET INTO MRISCANNER, R HIPHAS TO STAY FLEXED
8/24/14L4L5
L3L4
Readmitted 3/12/16 due to altered mental state and inability to walk, bone Scan to rule out occult fracture of the hip or pelvis or thigh
Optimal anatomy
L5S1
L4L5
L3L4
L2L3
L1L2
T12L1
T11T12
L5S1 L5L4L5
L4 L3L4 L2L3
L1L2T12L1
SURGERY 3/18/16
L1
L3
Thanks!