Lumbar Spine: Common Pathology and Interventions

Andrea Strayer

J Neurosci Nurs. 2005;37(4):181-193. 

In This Article

History and Review of Systems

  • Social history: Married, self-employed insurance agent. Travels extensively by car in a local area. Rare alcohol consumption, nonsmoker. Sedentary, can walk only about 2 blocks before experiencing pain.

  • Past medical history: Ulcerative colitis and gout.

  • Past surgical history: Chemonucleolysis L4-L5 and right knee surgery, remote.

  • Medications: Rofecoxib, mesalamine, enteric coated aspirin, daily vitamin, vitamin E.

  • Allergies: No known drug allergies.

  • Review of systems: Sedentary, no chest pain, palpitation, dyspnea on exertion; ulcerative colitis and gout in good control.

On neurological examination, his right foot dorsiflexion was weak–rated at a strength of 4/5. The remainder of his strength was intact. He was bilaterally areflexic at the knees and ankles. His sensation to pin prick was diminished in the bilateral lateral calf and his whole foot, bilaterally. An MRI scan revealed severe spinal canal stenosis at L3-L4 and L4-L5, as well as a herniated nucleus pulposus on the right at L5-S1 (Figs 11, 12).

DC underwent a L3-L5 decompressive laminectomy, and L5-S1 right microdiscectomy. Postoperatively, he had significant lumbar muscle spasm. Two days postoperatively he developed atrial flutter and was emergently cardioverted. His cardiac status prevented him from ambulating, which added to his back pain. Eight days after surgery, he was stable and discharged to home. Three months after surgery, DC was working full time and had resumed his usual activities, though some bilateral leg numbness and dorsiflexion weakness persisted. Physical therapy was ordered for low back stabilization exercise. At 6 months, DC experienced no weakness, and only minor toe numbness. Overall, he was very pleased with his surgical outcome.