50 year old woman with a surgical decompression laminectomy

Carmel Orthopedic & Sports Therapy

  • The patient is a 50 year old woman who works in a retail clothing store, underwent a surgical decompression laminectomy at the L 4-5 level, 2 months following a lifting incident in which she felt a burning "pop" in the lowback.

  • Patient was referred to physical therapy for treatment. She was treated with traction, modalities, spinal stabilization exercises. There was a gradual increase in pain and increasing weakness of the R tibalis anterior.

  • Two days post-op the patient was returned to surgery for closure of the dura, due to a leak of CSF. Within 36 hours, the patient developed a fever, and IV antibiotics were administered for a operative site infection.

  • Following 2 weeks of IV antibiotics, several lumbar punctures and a 6 week course of oral antibiotics, the patient was referred to physical therapy for rehabilitation.

  • Patient presents to physical therapy with acute pain and tenderness, radicular pain into the right leg to the mid-calf.

  • Range of motion of the lumbar spine is limited in all planes, with forward bending reproducing the pain into the RLE. Strength in the RLE L3-S1 is 4-/5 limited by pain during resistance. Slump Test is positive, Passive Straight Leg Raise is positive at 35 degrees, Active SLR cannot be performed. Sensation is -1 L4-5 dermatome and Patellar and Achilles reflexes are +1.

  • Patient cannot sit for more than 10 minutes without proper support, and cannot walk more than 200ft without rest.

  • The patient was seen by several therapists, and treated with modalities for pain, soft tissue and joint mobilization, spinal stabilization and home exercise. The patient made moderate progress and was able to return to work 2 days a week. The patient was not able to work two days in a row and was limited to minimal activity the following day.

  • The patient was referred to another therapist, ROM is limited in all motions, forward bending to 30 degrees, tenderness to palpation over the mid-lumbar spine is rated
    7-8/10, Passive Straight Leg Raise is limited to 45 degrees, Active Straight Leg Raise 10
    degrees.

  • A trial session was initiated on the ATM2, patient placed in a forward bending position and the straps adjusted to comfort, completely stabilizing the legs and pelvis. The patient performed five forward bending motions without pain. Then five additional movements, and then a resistance belt attached, and 10 more pain free forward bending motions were performed.

  • Active forward bending movements were performed to full range of motion without pain.

  • The ASLR and PSLR movements were performed, 50 degrees/ 80 degrees respectively. Tenderness to palpation over the lumber spine is now 1-2.

  • The patient was placed on a 3 times weekly regimen of ATM2 exercise, spinal stabilization and stretching at home.

  • Patient was able to return to work 3-4 days a week, with no post work day debilitation, and is able to care for her elderly mother.

  • The patient continues to strengthen and stretch and was discharged. The patient is going purchase an ATM2 unit to use at home to continue her rehabilitation.

Bud Ferrante, PT