postoperative sciatica in a lumbar fusion
TRANSCRIPT
Postoperative sciatica s/p
L4L5 posterior fusion
Upper Cheseapeake Medical Center Spine Conference Friday September 2, 2016
65 woman cc L sciaticaHPI 6 weeks sx PMH: RA, R TKA, HTN, anemia, paroxysmalAFIB, MEDS: lansoprazole, Metoprolol, antara, sertraline,Leflunomide, asa, humira,Digoxin, Cardizem, lyricaSH: marriedExam: 5’1” 188 lb
L4L5 PSF R PICBG, L L3L5 decompression, L4L5 discectomy with L L4 Hemilaminectomy; Intraoperatively R L4 screw had poor purchase, removed, palpated and the Screw was reinserted increasing the diameter from 6mm to 7mm
Note nerve rootFrom above lateralTo pedicle
Halo loosening sign
Halo loosening sign
No pain
R LBP buttock pain with radiation to anterior thigh and anterior leg
Sx started 3-4 weeks postoperativelycalled office 5 weeks postop and was given steroid packseen in office 7 weeks postop and examined, no infection, sent for imaging due to persistent symptoms
Images are 3 months postpo
5 weeks postop
DDX: Postoperative sciatica fusion
Early postop:Implant (screw) compressing nerveTraction neuropraxiaStenosis from disc, ligament, malalignmentInadequate decompressionRemoving distracting injury brings light to another painful problem
Late:InfectionNew stenosis, adjacent levelImplant looseningNot associated with surgery or spineHipPelvic or sacral fractureInstability
L3L4
L4
L4L5
L5
L5S1
L4
Superior L4
Inferior aspect L4
L5
R L4
thanks