Lecture failed laminectomy DRG compression
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Transcript of Lecture failed laminectomy DRG compression
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Failed Lumbar Laminectomy
• Upper Chesapeake Medical Center• Bel Air, Md• April 1, 2016
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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
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Kleeman, T.J., Hiscoe, A.C., Berg, E.E.: “Patient Outcomes Following Minimally DestabilizingLumbar Stenosis Decompression: The ‘Port Hole’ Technique”, Spine, April 2000.
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ULBD
laminectomy
Porthole/interlaminar fenestration
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ER visit for terrible leg pain 3/6/16
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PAIN SO SEVERETHAT HE CANNOTGET INTO MRISCANNER, R HIPHAS TO STAY FLEXED
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8/24/14L4L5
L3L4
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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
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Optimal anatomy
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L5S1
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L4L5
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L3L4
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L2L3
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L1L2
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T12L1
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T11T12
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L5S1 L5L4L5
L4 L3L4 L2L3
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L1L2T12L1
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SURGERY 3/18/16
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L1
L3
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Thanks!