Lumbar Stenosis
Patient Presentation
Patient TF is a 72 y/o female who complained of increased difficulty walking due to weakness and paresthesias in both legs. She reported severe low back pain that radiated down both legs. She also reported recent onset of bowel incontinence. PMH include DM, HTN, overweight, cervical laminectomy w/fusion, ulnar nerve entrapment release surgery, hysterectomy, and 2 ectopic pregnancies.
Differential List
TF was diagnosed with lumbar stenosis in the 1990’s. It has progressively worsened.
Diagnosis
MR imaging studies revealed severe and multilevel degenerative disk disease and stenosis from L2 down to the L4-5 junction. Surgical intervention on the lumbar spine followed by inpatient rehabilitation was elected in hopes to relieve pain and restore mobility and continence.
Treatment
TF presented to the Surgery Center for a scheduled lumbar surgery. The procedures performed were decompressive L2, L3, and L4 laminectomies, and bilateral L2-3, L3-4, and L 4-5 medial facetectomies. A Jackson-Pratt drain was placed. Steri-strips held the incision closed and this was covered with a sterile dressing.
Outcome
TF tolerated the procedure well and remained in stable condition throughout her stay with no complications. The pain in her lower back was initially controlled with IV and PO Dilaudid® with occasional 5mg PO Valium®; after about 4 days she was only taking oral Dilaudid®. On day 3 the JP drain was removed and the primary dressing was taken off to leave the Steri-strips open to air. The patient passed her voiding trial [Meaning she did not retain urine 6 hours post-Foley catheter removal (confirmed by bladder scan). Urinary retention is common with spine disorders; an over-distended bladder after lumbar surgery can lead to bleeding and hematoma formation at the surgical site which can cause permanent spinal cord damage and/or paralysis]. TF regained control of her bowels and was OOB to commode chair with standby assistance. The strength in her legs gradually improved over the next week until she was able to walk around the room slowly using a walker. The physical and occupational therapists recommended acute rehabilitation for gait training and continued work on ambulation and mobility. TF was discharged to a rehabilitation facility for inpatient rehabilitation after a 4-day hospitalization.