SpineUniverse Case Study Library

Progressive Pseudoclaudication in an Elderly Man

History

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.

Examination

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

Prior Treatment

Selective L3 nerve root injection offered temporary relief of pain. Three epidural steroid injections and organized physical therapy provided no relief of pain.

Pre-treatment Images

Severe central stenosis noted at L2-L3, L3-L4, L4-L5. Slight spondylolisthesis at L3-L4.Figure 1: Severe central stenosis noted at L2-L3, L3-L4, L4-L5. Slight spondylolisthesis at L3-L4. Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

Lumbar foraminal stenosis at multiple levelsFigure 2: Lumbar foraminal stenosis at multiple levels. Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

Coronal MRI shows mild scoliosis (right-bender)Figure 3: Coronal MRI shows mild scoliosis (right-bender). Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

axial L2-L3Figure 4: Axial L2-L3. Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

L3-L4 showing subluxation at right L3-L4 facet joint; severe stenosisFigure 5: L3-L4 showing subluxation at right L3-L4 facet joint; severe stenosis. Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

axial L4-L5Figure 6: Axial L4-L5. Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

Diagnosis

Multiple level lumbar spinal stenosis, L3-L4 degenerative spondylolisthesis, mild degenerative scoliosis

Suggest Treatment

Indicate how you would treat this patient by completing the following brief survey. Your response will be added to our survey results below.

Selected Treatment

Minimally invasive multiple level laminoforaminotomies with minimally invasive TLIF at L3-L4.

Post-treatment Images

TLIF L3-L4Figure 7: TLIF L3-L4. Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

TLIF L3-L4Figure 8: TLIF L3-L4. Image courtesy of James D. Schwender, MD, and SpineUniverse.com.

Outcome

The patient is doing great at 2 years post-op.

  • ODI:16
  • VAS: Leg 0
  • VAS: Back 3

Case Discussion

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.

Community Case Discussion (0 comments)

SpineUniverse invites spine professionals to share their thoughts on this case.


SHOW MAIN MENU
SHOW SUB MENU
Cancel
Delete

Get new patient cases delivered to your inbox

Sign up for our healthcare professional eNewsletter, SpineMonitor.
Sign Up!