Progressive Pseudoclaudication in an Elderly Man
The patient is a 72-year-old man with no medical co-morbidities. He presented with progressive pseudoclaudication over several years. Now, he's able to walk only 100 yards. There is no bowel/bladder dysfunction. Bilateral L3 radiculopathy was confirmed with EMG.
He is neurologically intact in all lower extremity motor groups.
- Sensation grossly intact
- Absent reflexes
- Good pulses
- ODI: 48
- VAS: Leg 7
- VAS: Back 5
Selective L3 nerve root injection offered temporary relief of pain. Three epidural steroid injections and organized physical therapy provided no relief of pain.
Multiple level lumbar spinal stenosis, L3-L4 degenerative spondylolisthesis, mild degenerative scoliosis
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Minimally invasive multiple level laminoforaminotomies with minimally invasive TLIF at L3-L4.
The patient is doing great at 2 years post-op.
- VAS: Leg 0
- VAS: Back 3
This gentleman presents with textbook neurogenic claudication. He's been treated appropriately with non-operative management and continues to have symptoms affecting his quality of life. Selective nerve root injections and EMG nerve conduction study confirmed single-level radiculopathy.
There appears to be a mild degenerative scoliosis by MRI, but the lack of 3-foot AP and lateral x-rays make it difficult to determine spinal balance.
The post-operative x-rays do show that a one-level anterior/posterior procedure was performed at L3-L4. This has resulted in a clinical success according to the patient's VAS, which went from 7 to 0 for leg pain and 5 to 3 for back pain.
It is difficult to determine whether there has been progression of the deformity without pre-operative x-rays for comparison. It does appear from a clinical standpoint that the procedure was successful and by performing a minimally access surgery, there hasn't been significant disruption of the posterior elements that could lead to progression of the deformity.