Facet Syndrome After Open Laminectomy
I am Dr. Tony Mork, endoscopic spine specialist. Today I would like to talk about someone who presented with back pain years after having a multilevel decompression at the L4-5, L5-S1 level and presenting with severe low back pain that is incapacitating.
In this particular case this lady was 73 years old and she had previous surgery 13 years ago, a wide decompressing laminectomy for stenosis at L4-5, L5-S1, which was successful. However, in the years following that she had progressive, incapacitating low back pain. She also had terrible looking discs which I can show you here on the MRI scan.
Pain Reduced by 90%
We can see here between L4-5 and L5-S1 that we have very narrow and collapsed disc spaces that have certainly caused significant arthritic changes in the facet joints which I will show you here. Here we see at the L4-5 level the wide decompressing laminectomy and the degenerative facet joints. So, in evaluating this lady it was a matter of injecting the short-acting anesthetic on the transverse processes here on both sides. I was evaluating her back pain, not paying particular attention to her discs, but rather looking specifically at the facet joint innervation where the dorsal primary rami nerve branches. The amazing thing about this lady, who is again morbidly obese with tremendous back pain, is that after the dorsal primary rami nerve blocks, she had virtually 90% relief of her pain - demonstrating that the pain was not coming from the discs but from the facet joints. So, here we have an example of a multi-decade history of back pain treated with open laminectomy, wide decompressing at L4-5 and L5-S1 with really incapacitating back pain in a very deconditioned, morbidly obese person who had almost complete relief of her back pain with the dorsal primary nerve branch blocks. So I scheduled her for a rhizotomy at three levels: At L3 transverse process, L4, L5, and then of course the S11 level, at which point postoperatively she had about 90% relief of her back pain with a simple outpatient procedure with the Wolf instrumentation as talked about by Dr. Tony Yeung.
So here is a case of a lady who had tremendous problems, tremendous pain, tremendously deconditioned, and yet with a very simple, small operation performed as an outpatient she was virtually relieved of all of her low back pain. If you have further questions either give the office a call or check out my website.