Post-Laminectomy Syndrome

Fig 1: Axial scan--scar tissue
(larger view)

Fig 2: MRI--degenerated disc
(larger view)

History of present illness

Over the years he has had extensive conservative treatment, which allowed him to control his back pain and leg pain and also to continue to stay functional. He is still working although with some restrictions, and this is considered a work-related injury. In the past year, he has missed more work and it is getting increasingly difficult for him to function at work within his current restrictions. The pain is worst when he is sitting, although he also cannot walk for long distances anymore. He is otherwise healthy and does not smoke.

Physical exam

On physical exam he has forward bending to his kneecaps only, and very limited extension. His reflexes are intact and symmetrical, and he has normal strength in all his muscle groups. He has a positive straight leg test on the left. He does not demonstrate any pain behavior and is otherwise easy to examine.

Imaging studies

MRI scans show severe degeneration at the L5-S1 level and no other levels of degeneration. There is a large anterior osteophyte (bone spur). There is a lot of disc space collapse present at the L5-S1 disc. The axial scan shows scar tissue around the L5 nerve root, but no evidence of a recurrent disc herniation.