Postoperative sciatica in a lumbar fusion
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Transcript of Postoperative sciatica in a lumbar fusion
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Postoperative sciatica s/p
L4L5 posterior fusion
Upper Cheseapeake Medical Center Spine Conference Friday September 2, 2016
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65 woman cc L sciaticaHPI 6 weeks sx PMH: RA, R TKA, HTN, anemia, paroxysmalAFIB, MEDS: lansoprazole, Metoprolol, antara, sertraline,Leflunomide, asa, humira,Digoxin, Cardizem, lyricaSH: marriedExam: 5’1” 188 lb
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L4L5 PSF R PICBG, L L3L5 decompression, L4L5 discectomy with L L4 Hemilaminectomy; Intraoperatively R L4 screw had poor purchase, removed, palpated and the Screw was reinserted increasing the diameter from 6mm to 7mm
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Note nerve rootFrom above lateralTo pedicle
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Halo loosening sign
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Halo loosening sign
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No pain
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R LBP buttock pain with radiation to anterior thigh and anterior leg
Sx started 3-4 weeks postoperativelycalled office 5 weeks postop and was given steroid packseen in office 7 weeks postop and examined, no infection, sent for imaging due to persistent symptoms
Images are 3 months postpo
5 weeks postop
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DDX: Postoperative sciatica fusion
Early postop:Implant (screw) compressing nerveTraction neuropraxiaStenosis from disc, ligament, malalignmentInadequate decompressionRemoving distracting injury brings light to another painful problem
Late:InfectionNew stenosis, adjacent levelImplant looseningNot associated with surgery or spineHipPelvic or sacral fractureInstability
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L3L4
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L4
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L4L5
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L5
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L5S1
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L4
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Superior L4
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Inferior aspect L4
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L5
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R L4
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thanks
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