Physician 1st Quarter 2016 Spine Surgery IRR - Case Study #6
68-year-old female with prior authorization request for L 4–5 laminectomy with TLIF with pedicle screw fixation.
Patient presented with low back pain and radiation into the post her bilateral lower extremities and feet for the last three years. The pain has progressively worsened with 60% pain in the legs and 40% in the lower back.
She had recent conservative care including formal physical therapy times 15 sessions with minimal relief as well as the use of NSAIDs without relief. The pain is worsened by standing and walking and she walks with a "hunched over" gait.
She has also undergone selective nerve root blocks in the past with minimal relief.
Her physical examination suggests a flexed gait posture with restricted range of motion of the lumbar spine in all planes and decreased sensation in the L4-5 distributions bilaterally.
X-rays and MRIs revealing grade II spondylolisthesis at L4–5 with severe central and bilateral foraminal stenosis at this level with compression upon the exiting L4 nerve roots.
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