Lecture failed laminectomy DRG compression

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!