Lecture failed laminectomy DRG compression
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A 68-year-old man presented with right lower extremity pain following a failed L2-L4 laminectomy in 2014. He had three months of pain relief but symptoms returned with terrible right lateral and anterior thigh pain that prevented walking without a walker. On exam, he had severe right quadriceps and hip flexor weakness. A lumbar laminectomy using the "port hole" technique was recommended to decompress the lumbar stenosis given the optimal lumbar anatomy and the severe pain preventing an MRI.
Lecture failed laminectomy DRG compression
- 1. Failed Lumbar Laminectomy • Upper Chesapeake Medical Center • Bel Air, Md • April 1, 2016
- 2. 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” 270 R quad 1/5, R hip flex 1/5, ankle DF 2/5
- 7. Kleeman, T.J., Hiscoe, A.C., Berg, E.E.: “Patient Outcomes Following Minimally Destabilizing Lumbar Stenosis Decompression: The ‘Port Hole’ Technique”, Spine, April 2000.
- 9. ER visit for terrible leg pain 3/6/16
- 10. PAIN SO SEVERE THAT HE CANNOT GET INTO MRI SCANNER, R HIP HAS TO STAY FLEXED
- 12. 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
- 13. Optimal anatomy
- 14. L5S1
- 15. L4L5
- 16. L3L4
- 17. L2L3
- 18. L1L2
- 19. T12L1
- 20. T11T12
- 24. L1L2 T12L1
- 37. SURGERY 3/18/16
- 40. L1 L3
- 41. Thanks!