|
Year |
2002 |
|---|---|
|
Question Number |
174 |
|
Category |
Spine |
Question
A 49-year-old woman has had severe pain in her right buttock and thigh and paresthesias into her right foot for the past 10 weeks. Lumbar epidural steroids have provided only temporary relief, physical therapy exacerbates her pain, and she feels that she is getting worse. Examination reveals mild weakness in her right extensor hallucis longus and a positive straight leg raising sign. Axial MRI scans are shown in Figure 47. Management should now consist of
1- observation and reevaluation in 6 weeks.
2- acupuncture.
3- repeat epidural steroids under fluoroscopic guidance.
4- L4-5 diskectomy and interbody fusion with cage fixation.
5- L4-5 hemilaminotomy and diskectomy.
Figures
Answer (click for answer)
Answer – 5
This patient has an L5 radiculopathy with no mention of axial back pain, and has failed non-operative measures including PT and epidural injection. She is a candidate for surgical intervention, so the first three choices are out. Open diskectomy through a limited laminotomy and microdiskectomy remain the gold standard procedures; 90% of properly selected patients experience successful short-term relief of symptoms. Neither the patient’s symptoms nor her MRI (no listhesis) indicate instability, so an interbody fusion is not warranted.
Reference: OKU 6