Lumbar Vertebrae Fusion Case Study

Deterior Lumbar Case
DOI: 8/6/1997. Patient is a 56–year–old male chief engineer who sustained a work related injury when he fell on a level on or against an object.
Patient is status post anterior lumbar interbody fusion at L3–4 and L4–5 with infuse, diskectomies with partial corpectomies and left cage
instrumentation per the operative report dated 04/26/04.
Per the PT attendance report dated 03/06/15, patent has attended 12 visits for the lower back.
As per medical report dated 2/18/16, patient complains of constant low back pain in a L4–5 distribution. Patient has undergone physical therapy as well
as medication management without amelioration of the pain and continues to be symptomatic. He had previous epidural steroid injection. He also had
acupuncture
... Get more on HelpWriting.net ...

Lumbar Fatigue: A Case Study
DOI: 10/20/2014. Patient is a 46–year–old male delivery driver who sustained injury while he was unloading fittings and flanges to job site. Per
OMNI, he was initially diagnosed with lower back strain/sprain.
The patient received a lumbar ESI at L5–S1 per procedure reports dated 06/02/15 and 08/25/15.
Based on the medical report dated 02/02/16, the patient complains of ongoing low back pain radiating into the right lower extremity with numbness,
tingling and dysesthesias despite therapy and epidurals. He engages in a home exercise program. Pain is rated as 8/10, described as on and off, dull
then sharp. Factors that worsen pain include lifting, carrying, bending, standing up, walking and sleeping.
The patient has had the following ... Show more content on Helpwriting.net ...
X–ray of the lumbar spine showed instability at L4/S1 spondylosis.
IW was diagnosed with lumbar herniated intervertebral disc, right lumbar radiculopathy, neurogenic claudication and spondylolisthesis.
Plan is for posterior spinal fusion laminectomy at L4, L5 and S1 levels.
Per the IME report dated 06/24/15 by Dr. Antoine, there is evidence of mild partial disability of 25%. It was opined that the IW's condition warrants
further orthopedic treatment, including PT 2 times a week for 6 weeks with re–evaluation upon completion, as well as lumbar ESI. Patient has
hypertension. He is 5 feet and 9 inches tall and weighs 260 pounds.
Per verification to the PT facility, the patient has attended 38 PT sessions for the back from 10/01/15 through 02/10/16.
Requested verification from the provider's office if this will be with or without contrast, and if this will be done pre or post–operatively, however, no
callback was received prior to the submission of this request to PA.
Is the request for 1 MRI of the Lumbar Spine between 2/10/2016 and 4/10/2016 medically necessary?
C–4 for Preauthorization Request.
(Kindly use the NY Medical Treatment Guideline as primary reference).
This is 2 of 2

Lumbar Discectomy
Discussion
The aim of the study was to determine the surgical outcome of lumbar discectomy as a treatment option for lumbar degenerative spine disease. This
study evaluated the outcomes after lumbar discectomy for degenerative spine disease at six months post operative period. From the study it is evident
that most of the patients benefited from surgery. The ODI questionnaire pertaining to tolerance of pain, well–being, walking, standing, sitting, personal
life, social life, lifting, traveling and sleeping was compared in the pre–operative and post–operative stages which clearly showed that there was a
significant change with reference to nearly all variables among post–operative patients. The study goes in line with the findings of literature

Lumbar Discectomy Lab Report
Abstract
Object
Lumbar spine surgery can be performed using a variety of anesthetic modalities, most notably general or spinal anesthesia. The aim of this study was to
determine if either anesthetic modality is more cost–effective in cases of lumbar discectomy or laminectomy spine surgery.
Methods
542 patients who underwent elective lumbar spine surgery at the University of Pennsylvania between 2007–2011 performed by a single faculty surgeon
were retrospectively identified, with 364 having received spinal anesthesia and 178 having received general anesthesia. Demographic, physiological,
and cost data were collected retrospectively. Mean direct operating cost, indirect cost, and total cost were compared among patients who received
general and ... Show more content on Helpwriting.net ...
This may partly be a consequence of the fact that the standard technique for general anesthesia is endotracheal intubation. 6 Since prone positioning
increases the risk of airway compromise, anesthesiologists may prefer secure airway establishment with endotracheal intubation. 5 Another reason
could be that surgeons are able to perform longer operations using general anesthesia or that there is greater patient acceptance and comfort. 15 Though
these considerations should definitely be taken into account, the health, efficiency, and cost benefits of spinal anesthesia cannot be ignored.
As with any retrospective study, the strength of the conclusions presented in this study are limited by the potential for selection bias. We did employ a
multivariate regression analysis to control for possible cofounding variables, but recognize that we could not identify and account for all factors that
may have influenced cost. It should also be emphasized that regional variations in surgical care and cost exist, which implies that our conclusions may
not be applicable to other institutions. 19 These limitations would be overcome with future prospective randomized controlled studies at various

Epilepsy: Lumbar Seizure
Epilepsy is a brain disorder in which clusters of nerve cells also called neurons inside the brain signal unusually or in which case the brains neurological
pattern also called the electrical pattern is disrupted. Neurons inside the brain usually generate electrochemical impulses that communicate with other
neurons. In Epilepsy, the usual pattern of neurological activity becomes distorted, causing odd sensations such as behavioral and emotional, muscle
spasms, sometimes convulsions and loss of consciousness can occur. Seizure disorders originate from a pathogenic process, head trauma, metabolic
processes, exogenous or endogenous poisons, and a simple fever. Seizures may be a result from an exposure to many types of poisons such as lead
and carbon monoxide but it can also ... Show more content on Helpwriting.net ...
a small amount of spinal fluid can be then removed and tested to determine if there is some type of infection or other underlying medical problems.
Lumbar Puncture can also be used to measure the pressure of the spinal canal and measure the brain. Research has shown that the cell membrane that
surrounds every neuron has an important role in Epilepsy, these membranes are responsible for the neurons to generate an electrical impulse and for
some reason when the brain attempts to repair itself after head trauma, stroke, or another problem that may generate atypical nerve connections that
will lead to Epilepsy. Studies in animals have also provided that because the brain constantly adapts to changes in a small change in neurological
activity, if repeated this may increase the chances of a full blown epileptic attack. Anomalies in the brain connections that happen while the brain
develops may also disrupt neurological activity which could lead to Epilepsy. Research has also shown that the repeated attacks of the temporal lobe
can cause the hippocampus to shrink, the hippocampus is responsible for learning and memorization, but it may however take years for such a seizure
attack to do significant

Case Study Of Vertebrae
The adult vertebral column usually consists of 33 vertebral segments. the usual number of vertebrae is 7 cervical, 12 thoracic, 5 lumbar, 5 sacral
and 4 coccygeal, the fifth lumbar vertebra may be wholly or partially incorporated into the sacrum. The five lumbar vertebrae are distinguished by
their large size and the absence of costal facets and transverse foramina. The body is transversely wide [1]. Congenital fusion of cervical vertebral
bodies is a common finding, where as the incidence of fused thoracic vertebrae is less frequent and fusion of lumbar vertebral bodies is rare. Sharma
reported fusion of upper cervical vertebrae 6.25%. Two Thoracic vertebrae in two thoracic spines were fused in 4.16%. Twolumbar vertebrae of one
lumbar ... Show more content on Helpwriting.net ...
If fusion occurs in cervical level it causes restriction of motion, short neck, torticollis, and neurological abnormalities of variable degree, depending on
the extent of involvement and the type and number of the associated malformations. Abnormal degrees of motion at the unfused levels may be
responsible for impingement on neural structures. Although block vertebrae are most commonly found in the cervical region, they can also be found
throughout the spine. Individuals with block vertebrae, when viewed through MRI, typically show calcified disk space, fusion of apophyseal joints,
and malformation or fusion of the spinous processes. They may also suffer from muscle weakness and/or atrophy, and neurological sensory loss.
Vertebral fusion is often limited to the thoracic and lumbar spine in ankylosing spondylitis where spinal abnormalities initially appear in the
thoracolumbar and lumbosacral junctions and may subsequently extend to the remainder of the spine. Classic radiographic abnormalities include thin,
vertically oriented syndesmophytes [4]. Congenital deformities of the spine 0.5/1000 births [5], identified at birth are due to anomalous vertebral
development in the embryo caused by genetic and environmental influences that occur during somitogenesis around the third week after fertilization.
Minor bony malformations of all types occur in 12% of the general population and are usually not apparent, often diagnosed only on routine chest films
or

Lumbar Spine: A Case Summary
DOI: 12/14/1995. Patient is a 66 year–old male truck driver who sustained injury to his back while unloading a truck by hand. Per OMNI, patient is
diagnosed with failed back syndrome. MRI of the lumbar spine dated 6/9/16 revealed postsurgical changes of the lumbar spine with resection of the
posterior elements from L1–L2 to L5–S1 and mild to moderate disc degenerative disease of the lumbar spine at T12–L1, L2–L3 and L3–L4. Per
progress report dated 5/03/2016, patient presents for follow up evaluation. He reports that he decided not to proceed with the pain pump trial as he does
not want to add more medication to his regiment. He would prefer to start physical therapy for his pain instead of medication. He has been able to
control his pain with regimen. He notes at least 40% improvement with ... Show more content on Helpwriting.net ...
Since the last visit dated 5/3/16, he states that he has been doing well. He notes that the physical therapy has been going well. He notices his pain
and range of motion is improving. The patient notes that at least 30% improvement with physical therapy and at least 40% improvement with
Vicodin. He also notes that at least 30% improvement while on his medication. He notes that he is able to get up out of bed, keep up with his
hygiene, shop, and cook. He notes overall good improvement. The pain scale is 7/10 since his last visit on 5/3/16. Cervical spine examination
revealed that range of motion is restricted with lateral rotation to the left limited to degrees due to pain and lateral rotation to the right limited to
degrees due to pain but with normal flexion, extension, right lateral bending and left lateral bending. On lumbar spine, there is tenderness on the
bilateral paravertebral muscles. Spurling's maneuver causes pain. Lumbar facet loading is positive on both sides. Tenderness is also noted over the
sacroiliac spine. Current medications include Ambien 10 mg, ibuprofen, and Vicodin

Lumbar Fracture Research Paper
Lumbar Fracture
A lumbar fracture is a break in one of the bones of the lower back. Lumbar fractures range in severity. Severe fractures can damage the spinal cord.
CAUSES
This condition may be caused by:
A fall (common).
A car accident (common).
A gunshot wound.
A direct blow to the back.
Osteoporosis.
SYMPTOMS
The main symptom of this condition is severe pain in the lower back. If a fracture is complex or severe there may also be:
A misshapen or swollen area on the lower back.
A limited ability to move an area on the lower back.
An inability to empty the bladder or bowel.

A loss of strength or sensation in the legs, feet, and toes.
Paralysis.
DIAGNOSIS
This condition is diagnosed based on:
A ... Show more content on Helpwriting.net ...
If you were shown how to do any exercises to improve motion and strength in your back, do them as directed by your health care provider.
Return to your normal activities as directed by your health care provider. Ask your health care provider what activities are safe for you.
Other Instructions
If you were given a neck or back brace, wear it as directed by your health care provider.
Keep all follow–up visits as directed by your health care provider. This is important. Failure to follow–up as recommended could result in permanent
injury, disability, and long–lasting (chronic) pain.
SEEK MEDICAL CARE IF:
Your pain does not improve over time.
You have a persistent cough.
You cannot return to your normal activities as planned or expected.
SEEK IMMEDIATE MEDICAL CARE IF:
You have severe pain or your pain suddenly gets worse.
You are unable to move.
You have numbness, tingling, weakness, or paralysis in any part of your body.

You cannot control your bladder or bowel.
You have difficulty breathing.
You have a fever.
You have chest or abdominal pain.
You

Evaluation, Diagnosis, And Therapeutic Interventions
1. The article has discussed only four elements out of five in the given case. The four elements such as clinical examination, evaluation, diagnosis, and
therapeutic interventions are well explained in this study but there is not enough information on prognosis. Croft et al (2015) stated that through
information on patient prognosis we could coordinate data from biological, social, and clinical database for more powerful and productive care in this
advanced medicinal world. The prognosis indicates possible future outcomes in patients with given conditions or health problems. 2. Examination: The
examination of the given case study includes the patient 's all basic information such as age, occupation, work hours, physical demand, and... Show
more content on Helpwriting.net ...
A diagnosis is well–explained and interventions are also timely scheduled, but there is not enough information on expected outcomes from each
intervention. Intervention: A well– designed therapeutic treatment plan was implemented following thorough examination, evaluation, and diagnosis.
Initially, the patient was given grade IV manual mobilization in the affected thoracolumbar (T10 to L2 vertebrae) region to reduce the pain and
minimize spinal restriction (Doubleday et al., 2003). Also, the PT added psoas muscle stretching in prone position and pelvis was stabilized with the
mobilization belt. In later visits, the PT added the trunk, abdominal and lower–extremity muscle strengthening exercises in different positions, and
balance exercises in single and double–limb standing. 3. Visceral pain originates from the internal body organs such as respiratory, digestive,
urogenital, and endocrine systems, the spleen, the heart, and the great blood vessels (Goodman & Snyder, 2013). Visceral pain is not localized, and it
usually produces referred pain. Initially, the signs of visceral disease can be observed as "sensory, motor, and/or trophic changes in skin, subcutaneous
tissues, and muscles, and the symptoms can be itching, dysesthesia, skin temperature changes, or dry skin" (Goodman & Snyder, 2013, p.113). Signs
and symptoms of visceral problems are associated with Autonomic Nervous System responses such as the change in pulse rate,

Physical Therapy : Spine ( Lumbar / Cervical Thoracic )
1.Physical Therapy 3X6 – Spine (Lumbar/Cervical/Thoracic) Regarding Physical Therapy 3X6–Spine (Lumbar/Cervical/Thoracic); CA MTUS
supports an initial course of physical therapy with objective functional deficits and functional goals. The claimant has basically whole body pain with
limitations in range of motion and tenderness in most all body parts. Medical necessity has been established. However, initial 6 visits are given.
Additional requests should include functional improvement, discussion of functional goals and patient's progress in meeting these goals. Recommend
modified certification of PT 2X3 Spine (Lumbar/Cervical/Thoracic). 2. MRI – Spine (Lumbar/Cervical/Thoracic) Regarding MRI–Spine (Lumbar
/Cervical/Thoracic); the... Show more content on Helpwriting.net ...
However, plain films were not obtained. There is no clear rationale for the indication of shoulder MRI with unequivocal objective findings and absence
of plain films. In addition, there is no focal neurological deficit on the exam. There are no sensory or motor deficits noted. Medical necessity has not
been established. Recommend non–certification. 4. MRI – right wrist Regarding MRI right wrist; CA MTUS criteria for hand/wrist MRI include
normal radiographs and acute hand or wrist trauma or chronic wrist pain with a suspicion for a specific pathology. However, as noted above, no plain
films were obtained. There is no documentation or indication of an acute trauma to the wrist. Recommend non–certification. 5. MRI – Left knee
Regarding MRI left knee; CA MTUS recommends MRI for an unstable knee with documented episodes of locking, popping, giving way, recurrent
effusion, clear signs of a bucket handle tear, or to determine extent of ACL tear preoperatively. In addition, ODG criteria include acute trauma to the
knee, significant trauma, suspect posterior knee dislocation; nontraumatic knee pain and initial plain radiographs either nondiagnostic or suggesting
internal derangement. This is a chronic injury patient. There is no documentation of any acute injury to the knees. In addition, there is no
documentation of locking, giving away, recurrent effusion, or signs of a bucket handle tear

Lumbar Spine Case Summary
DOI: 7/14/2015. Patient is a 32–year–old male carpenter who sustained a work–related injury when he slipped with tanks falling on him as he was
moving cart with cutting torch and tanks uphill. As per Omni, the patient has herniation at L4–L5 level.
Radiology report of the lumbar spine dated 07/17/15 revealed mild degenerative changes at L4–L5. There is slight anterior subluxation of L4 on L5 by
about 4–5mm with probable right spondylolysis of L4.
MRI of the lumbar spine dated 07/24/15 showed degenerated L4–L5 disc. There is a significant foraminal narrowing at L4–L5 on the left with
effacement of the left L4 nerve root.
Based on the medical report dated 12/28/15, the patient continues to report lower back pain that radiated to his left leg to his anterior/lateral thigh and
anterior lower leg (shin) to his ankle and paresthesias. He has completed a conservative course of PT in which he underwent aquatic therapy. He was
seen in October of ... Show more content on Helpwriting.net ...
No sensory deficit is noted.
The patient has some weakness in his left anterior tibialis (4/5) and subtle weakness in his left quadriceps.
IW was diagnosed with osteoarthritis of the lumbar spine with radiculopathy.
MD noted that previous MRI from earlier this year showed a severely degenerated L4–5 disc with narrowing of the lateral recess bilaterally and the
inferior aspect of both foramina. There is a bulge that goes laterally on the Left side of the foramen with greater compromise. The quality of the open
air MRI is of quite poor quality. Seeing the persistence of the patient's symptoms, MD has recommended a repeat MRI with a stronger magnet to
improve the quality of the study. The patient is again currently scheduled to see Dr. Sitzman in referral for possible ESl at L4–5 on the left side.
Patient was given prescriptions for Percocet, Flexeril, Neurontin and Mobic.
Current request is for 1 MRI of the Lumbar Spine without Contrast between 1/29/2016 and

Lumbar Case Studies
SSDI and Lumbar Spinal Stenosis Lumbar spinal stenosis is what occurs when the nerves in the lumbar area of the spine (the lower back) are
pinched. Sciatica, which is the common term for pain in the legs due to a compressed nerve, can be caused by lumbar stenosis. It is mostly caused
by degeneration of the facet joints, or the joints between vertebrae, in the lumbar area, which expand and press against the spine and "choke" it,
hence the term stenosis, which comes from the Greek word for choking. The condition occurs mostly in older people, as aging is the most common
risk factor for degeneration of facet joints. However, younger people with other spinal conditions may also be at risk for developing lumbar stenosis.
Symptoms of lumbar... Show more content on Helpwriting.net ...
The exercises will be catered toward your specific pain areas so that your comfort is maximized. You can also take OTC or prescription painkillers in
addition to taking part in these exercises, or your doctor may recommend epidural steroid injections. Furthermore, if you experience little to no relief
from your symptoms, there are also surgical options for lumbar spinal stenosis. Based on the qualifications for SSDI, if you and your doctor are
considering surgery, you likely have such restricted movement that you would be considered disabled. Luckily, the laminectomy, one of the more
common surgeries for lumbar stenosis, has a high success rate in improving functioning. The above mentioned hospitals can also administer all of these
treatments – use their websites to find a treatment center near

Essay On Wound Drainage
The orthopedic literature has a long history of investigating the use of postoperative wound drains (Cobb, 1990). In total joint arthroplasty, wound
drains were associated with increased rates of transfusion (Hallstrom and Steele, 1992; Quinn et al., 2015) but not a decrease in the rate of wound
complications. A systematic review of the orthopedic literature comparing closed suctiondrainage systems with no drainage system for all types of
elective and emergency orthopedic surgery found that there is insufficient evidence from randomized trials to support the routine use of wound drains in
orthopedic surgery (Parker et al., 2007). Similarly, a meta–analysis of randomized controlled trials of wound drainage after hip fracture surgery ... Show
more content on Helpwriting.net ...
They found that the group without drains developed epidural fluid collection by MRI detection at a much higher rate of 89% compared to the drain
group at 36% (Mirzai et al., 2006). Their data suggested that drains could help clear excess fluid from the surgical site and adjacent spaces. However,
they did not observe a difference in clinical outcomes between groups. A meta–analysis of seven studies of postoperative suction drain use after
posterior spine surgery included 2,098 patients and found that drains did not influence healing rates and or infection (Andrew Glennie et al., 2015). The
relationship between surgical drains and hematoma prevention could not be established. Similarly, another recent meta–analysis failed to demonstrate
an association between surgical site drains and decreased odds of hematoma and infection (Waly et al., 2015). While the benefit of surgical site drains
in the lumbar spine remains to be demonstrated, the benefit of surgical site drains in the cervical spine remains an unanswered question.
The study of surgical site drains in the posterior cervical spine is limited. Payhs et al. suggested surgical site drains in the posterior cervical spine in
combination with alcohol foam or vancomycin powder are associated with reduced odds of surgical site infection among patients undergoing any
posterior cervical spine surgery (Pahys et al., 2013). Our data regarding

Lumbar Pain Case Studies
REASON CHIEF COMPLAINT: Cervical and lumbar pain. HISTORY The patient is a 62–year–old male with a long history of cervical and lumbar
pain secondary to degenerative disk disease and spondylosis. He also is noted to have multiple other problems including a fairly severe left rotator
cuff arthropathy which does require surgery on the left. It is important to note that this is important because the patient has been wheelchair bound
since 2013 and now has difficulty with ambulation. He also has a history of prior cervical decompression in the remote past at C3–4. The patient
complains of both cervical and lower extremity pain as well as radiating symptoms in the left upper extremity all the way down into the level of the
hand. He denies... Show more content on Helpwriting.net ...
Both in the cervical and lumbar region. In terms of conservative management, the patient may benefit from the addition of an SNRI and either
gabapentin or pregabalin. He could also benefit from a tricyclic. I did discuss all of these with the patient and he is fairly adverse to the use of any of
these types of medications because of feelings that it will affect his liver. At the same time, he is currently on methadone which he states does not seem
to help him as much as morphine has in the past. A switch to extended release morphine sulfate could be performed and would help in terms of not only
his neuropathic pain, but also his nociceptive pain. In terms of injection therapy, I did discuss both cervical and lumbar injection therapy with the
patient. I went through with him the indications, risks, benefits, alternatives of care, likely outcome, possible complications, including but not limited
to the risk of bleeding, infection, nerve injury, spinal cord injury that could be associated with injection therapy. Furthermore, because of the fact that
he is a diabetic, he would be at increased risk with regards to hyperglycemia after the injection and also at increased risk for infection in general. At the
same time, I did review with him the rare but catastrophic adverse events including blindness,

Lumbar Lordosis Case Summary
The patient is a 36–year–old individual who sustained an injury on 01/30/17 due to lifting.
The patient was diagnosed with lumbosacral spine strain.
Treatments rendered to date included medications, physical therapy, 3 sessions of acupuncture treatment, an e–stim unit, and lumbar back support.
Past medical history was significant for hypertension.
X–ray of the lumbosacral spine dated 01/30/17 revealed normal results.
An MRI of the lumbar spine dated 03/23/17 revealed broad–based central 4 mm subligamentous disc protrusion and annular tear at L4–L5. There was a
2.7 mm subligamentous disc protrusion centrally at L5–S1. Neither of these two levels demonstrated compressive discopathy, central canal stenosis or
foraminal impingement. There was a mild straightening of the normal lumbar ... Show more content on Helpwriting.net ...
He described the pain as a constant, dull achy sensation that was aggravated by prolonged walking, bending forward or backward at the waist and
by squatting. He states his pain level was decreased with medications. He reported that Voltaren ge works better for him than any of the oral
medications. He also has completed 3 sessions of acupuncture and has 3 more remaining. The patient reported that his lower back pain was decreased
with acupuncture. He continued to wear a double back lumbar support as directed. His examination revealed tenderness to palpation over the midline
lumbar spinous processes and paravertebral muscles bilaterally. There was a decreased active range of motion with pain at 40 degrees of flexion, 10
degrees of extension and at the limits of full right and left lateral bending and rotation. The patient can perform 50% of the normal squat but complained
of increased pain as he returned to an upright position. The neurovascular status was intact for the lower extremities. The treatment plan included
additional acupuncture

Lumbar Spinal Stenosis Case Study
Operative Management of Lumbar Spinal Stenosis
Introduction
Lumbar Spinal Stenosis (LSS) affects a significant proportion of people in the population and can cause discomfort, limit activities of daily living, and
can lead to significant disability. Even though numerous technological advancements have been made in the treatment of LSS, its management
continues to be a challenge for both patients and healthcare professionals. Spinal Stenosis is a condition characterized by either narrowing of the
spinal canal, also known as the Central Stenosis, or narrowing of the vertebral foramina (Delitto et al., 466). The combination effect of the loss of disc
space, osteophytes, and hypertrophic lingamentum culminate to LSS (Genevay and Atlas 253). LSS is referred to as degenerative arthritis and the
foraminal narrowing leads to a condition referred to as neurogenic claudication. Because of this narrowing, the spinal cord, and the spinal nerves are
compressed thereby causing painful symptoms in the organs served by the affected nerves (Fishman 1141). Patients with this condition present with
symptoms ranging from low back pain, general weakness decreased sensation to numbness of the limbs (Delitto et al., 467). Walking becomes a
problem for people with this ... Show more content on Helpwriting.net ...
(Mueller, Paul. 7). Non–Steroidal Anti–inflammatory Drugs (NSAIDS) demonstrate effectiveness when used in reducing swelling and pain associated
with LSS (Fishman 1142). Opioids, on the other hand, are used to relieve pains associated with LSS and are usually only reserved for cases that do
not respond to non–opioid analgesics. Other drugs including gabapentin have been used to combat neuropathic pain. Pregabalin is commonly used in
the management of burning pain emanating from nerve root irritation (Frontera, Silver, and Rizzo

Lumbar Case Summary
DOI: 12/09/2000. This is a 58–year–old male sanitary engineer who sustained an injury to the low back when he fell while stepping down a ladder.
Patient is diagnosed with other intervertebral disc degeneration, lumbar region. He is status post lumbar spine surgery on 05/19/2006. Per medical
report dated 5/26/16, the patient complains of lower back pain which has increased since his last visit, rated as 9/10 without medication. His quality
of sleep is poor and activity level remains the same. As per office notes dated 6/26/16, the patient rates his pain as 9 with medications and 10 if without
medication. He states that the medication is working well and no side effects noted. CURES (Controlled Substance Utilization Review and Evaluation
System)... Show more content on Helpwriting.net ...
Review of diagnostic studies and medical–legal reports is included in the physician's notes. Objective findings note that the patient is mildly obese
and appears to be in moderate pain. He does not show signs of intoxication or withdrawal. His gait is antalgic gait and is assisted by cane. Lumbar
range of motion is restricted with 50 degrees of flexion, 10 degrees of extension, 10 degrees of right lateral bending, and 10 degrees of left lateral
bending. All range of motion is limited by pain. There is tenderness noted in the bilateral paravertebral muscles. Lumbar facet loading is positive on
the left side. Ankle jerk is Вј on the right and 2/4 on the left. Patellar jerk is Вј on the right side and 2/4 on the left side. There is tenderness noted over
the trochanter and pain to the lateral hip with range of motion. Right side motor strength of ankle dorsi flexor is 4/5 and ankle plantar flexor is 4/5.
Hip flexor is 5–/5. Light touch sensation is decreased over the lateral calf on the left. Patient has resting tremor of the left lower extremity. His
medications are Prilosec 20mg, Celebrex 200mg, Neurontin 800mg, Flexeril 10mg, Duragesic 75mcg/hour patch, Viagra 100mg, Nuvigil 150mg, and
Silenor 6mg, Evzio 0.4 mg, and Norco

Fibromyalgia Case Study
DIAGNOSIS Due the patient's symptom reproduction with the straight–leg–raise test, the SLR measurements remaining between 30–60 degrees hip
flexion, the positive slump test, the described radicular pattern, and diminished Achilles DTR the therapist concluded that the examination findings
were consistent with the medical diagnosis of L5/S1 disc herniation with associated nerve root involvement. (CITE) Therefore, the physical therapists
diagnosis was practice pattern 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated
with Spinal Disorders. (CITE) Once tested, the sacroiliac (SI) tests determined SI joint dysfunction which warranted interventions to improve SI joint
mobility. (CITE)... Show more content on Helpwriting.net ...
The rationale for this plan was that reducing muscle guarding and tone surrounding the lumbar spine to allow for greater lumbar and bilateral LE
AROM aiding in a decrease of symptoms. Once acute symptoms were managed, incorporation of stabilization techniques, strengthening and aerobic
exercise would be prescribed to reduce the risk of lumbar re–injury and control fibromyalgia symptoms, addressing the musculoskeletal and
neuromuscular examination findings. It was recommended that the patient's intervention plan consist of 2–3 sessions a week for 4 weeks. After 4
weeks the patient's progress would be measured to determine the efficacy of the current POC. The patient's progress would be informally measured
prior to each treatment session with a subjective pain rating and patient feedback regarding any improvements, declines, or stasis in the patient's

Lumbar Fusion Case Study
DOI: 5/1/2009. Patient is a 58–year–old male truck driver who sustained a work–related injury while he was on top of a load to loosen strap, when he
lost his balance and suddenly jerked. As per OMNI entry, he underwent L4–L5 lumbar fusion with hardware on 3/28/2011, screw removal on 4/7/2011
and removal of hardware at L4–5, with inspection of fusion mass and revision of posterior spinal fusion on 04/22/13. CT of the lumbar spine without
contrast dated 11/3/15 revealed post–surgical changes at L4–5 and L5–S1. Overall, there is very limited examination due to patient's body habitus, with
multilevel spondylosis. Findings are most notable at L4–5 where there is bilateral neural foraminal stenosis. There is atherosclerotic disease. There are
few

Lumbar Spine
IAT is reporting they received an adverse verdict in the amount of $2,305,376 on 10/13/16, with likelihood the plaintiff will be awarded additional
monetary damages based on jurisdictional laws. This loss involves a middle age female who was boarding the insured's shuttle bus at the Louis
Armstrong Airport in New Orleans, LA. On 1120/11, the insured operator, a new employee, failed to properly place the shuttle bus in park, causing
the bus to shift resulting in the plaintiff briefly loosing her balance. According to the insured operator, the plaintiff never fell and disembarked the
shuttle with no injuries. Due to the incident of 11/20/11, the plaintiff is alleging she sustained significant injuries as result of the insured operator's
failure to properly park the bus. Since the date of loss and over a three year period, the plaintiff had undergone multiple surgeries involving the neck,
back, both knees and left foot. The plaintiff has been diagnosis with multiple herniated disc of the cervical spine requiring a discectomy, multiple
herniated disc of the lumbar spine resulting in a spinal fusion, right & left medial meniscus and ACL tears requiring surgical intervention and a
metatarsal fusion of the left foot. In addition to the aforementioned injuries, the plaintiff has experienced ongoing episodes of depression and
incontinence. .... Show more content on Helpwriting.net ...
On 12/20/16, JLT issued a revised notice, noting our 30% share is $219,087. This notice is also flawed with JLT Re providing the incorrect
outstanding loss and expense figures. This was further complicated by IAT, who posted the incorrect outstanding loss amount on their 12/14/16 claim
financial sheet noting the outstanding loss reserve of $27.5 million. According to IAT's 09/21/16 reinsurance report the outstanding loss reserve is
$2,750,000 with a total incurred of

Lumbar Surgery Case Study
DOI: 1/5/2007. Patient is a 51–year–old male supervisor who sustained a low back injury while lifting a platform scale with another employee. Per
OMNI, he is status post lumbar surgery and right hip strain/pain. On the QME report by Dr. Raskin dated 2/3/2009, the IW was deemed to have
reached P & S status with 16% partial disability. Future medical care includes: medications, physical therapy, MRI, and injection. MRI of the lumbar
spine dated 10/16/2012 revealed possible partial left laminectomy at L4 and L5; L3–4. A 2.9 mm disc bulge which mildly impresses on the thecal sac
and produces mild bilateral neural foraminal narrowing; L4–5, a 5.0 mm broad–based disc protrusion which moderately impresses on the thecal sac;
and L5–S1, a 3.5 mm circumferential

Lumbar Fusion Case Studies
DOI: 10/11/2001. Patient is a 51–year–old female tandem system operator who sustained a work–related injury while she was pushing sleeve off the
top deck and felt muscle pull in low back and left leg. Per OMNI, she underwent laminectomy and discectomy on 7/23/2002 and another
decompression laminectomy on 8/28/2007. She had dorsal column stimulator surgery on 10/14/2008 and reposition on 3/9/2009. This was then
removed in November of 2010.
MRI of the lumbar spine without contrast dated 5/23/11 revealed L4–5 status post anterior lumbar fusion, left posterior lumbar fusion and left L4
hemilaminotomy. The anterior fusion plug projects into the central/left ventral epidural space by 2mm. Granulation tissue is present within the
laminotomy defect ... Show more content on Helpwriting.net ...
Diagnoses include lumbar region radiculopathy and spinal stenosis.
Per previous reviews, there was a previous denial for 1 Lumbar Epidural Steroid Injection at Left L5–S1 Level last 07/11/16. Attached is the peer report
for additional reference (Review 267045).
On the statement of medical necessity per MG–2 form dated 10/18/16, the patient wants to repeat left L5–S1 x 1 for longer lasting pain relief. History
and physical examination was consistent with lumbar radiculopathy/radiculitis (radiating pain and concordant MRI findings). She has failed
conservative treatment options including nonsteroidal anti–inflammatory drugs (NSAIDS),exercise, core strengthening and PT. Pain limits the patient's
function, as well as restricts Activities of Daily Living. It is reasonable to try a left L5–S1 ESI x 1 for pain relief. If there will be no benefit, an
interlinear approach will be attempted.
Requested verification from the provider's office on the IW's response from the last ESI on 04/12/16, and if IW has had recent PT and MRI for the
lumbar spine; however, no callback was received prior to the submission of this request to

Lumbar Spine
One of the studies that included the risk factors of the lumbar spine in relation to overweight was that of (Liuke et al., 2005), with 129 working middle
aged man study from a cohort of 1832 men representing the occupations of machine divers, construction carpenters and office workers. The selection
was based on the participant's age (40–45 years old) and place of residence. More specifically, they measure with MRI the signal intensity of the
nucleus pulposus of the discs L2/L3–L4/L5 using the adjacent cerebrospinal fluid as an intense reference. The questioner of this research was based
upon the weight at age 25 and 40–45, history of car driving, smoking and back injuries. The results of these measurements are multiple regression
analyses... Show more content on Helpwriting.net ...
Liuke M., Soloviena S., Lamminem A., Luoma K., Leino–Arjas P., Luukkonen R. and Riihimaki H. (2005) Disc degeneration of the lumbar spine in
relation to overweight. International Journal of Obesity. 29 (5).p. 903–908. DeterminantOR95% CIOR95% CI BaselineFollow up Occupation
Construction carpenter Machine operator Office worker 2.2 1.3 1.00.8–5.5 0.5–3.11.8 1.3 1.00.7–4.9 0.5–3.2 History of accidental back injuries before
baseline One or more injuries No injury 1.2 1.0 0.5–2.8 1.2 1.00.5–2.8 Overweight BMI в‰Ґ 25 Kg/m2 at age of 25 and 40–45 BMI в‰Ґ 25 Kg/m2
either at age of 25 or 40–45 BMI < 25 Kg/m2 at age of 25 and 40–45 1.6 1.1 1.00.6–4.4 0.5–2.44.3 0.9 1.01.3–14.3 0.4–2.0 Smoking status at baseline
Smoker Ex–smoker Non–smoker 1.2 0.9 1.00.5–2.6 0.4–2.00.6 0.6

Lumbar Disc Pathology
A Literature Review on Pertinent Imaging Findings for Lumbar Disc Pathology What these Images Are Holding to Guide in Physical Therapy
Treatments Physical therapists provide a multi–approach in treatment of discogenic low back pain. Most of the common approaches available include
manual therapy, lumbar stabilization, yoga, swimming and traction. Depending on the stage and severity of disk pathology, it is mostly a therapist's
preference when it comes to what intervention is applied. There are no clear–cut, well–defined practice guidelines as when is it more meaningful and
effective to choose manual therapy for this stage of disc pathology, versus that of traction for another phase. Hence, this literature study will try to look
into the more... Show more content on Helpwriting.net ...
However, there are some important concepts such as avoidance of axial loading when prescribing exercises to patients with disc pathology as this is
strongly related to degenerative changes although there is no gold standard tool for measuring lumbar compression load (Hung, Y.J.et al., 2014). Hours
spent sitting significantly increased the prevalence of disc herniation. Sitting is also associated with loss of the lumbar lordosis, intervertebral disc
(IVD) compression, and height loss, possibly increasing the risk of lower back pain (Fryer, J.C., Quon, J. A., & Smith, F. W. (2010). Hence, offering
variable positions when exercising patients best minimizes seated exercises. Little is known about the correlation between the extent of disc herniation
and clinical signs and symptoms, neither were there any reported correlation between improvement in functions nor the pain reduction as visually
reported, other than the reduction in sizes of disc herniation among the four segment levels (L2 –L3 = n 6, L3–L4 n=17, L4– L5 n= 51 c, and L5– S1
n= 4), indicative of morphological regression of herniated disk during their repeated MR as reported by the research of Unlu, Tasci, Tarhan, Pabuscu,
& Islak in 2008. Hence, physical assessment and a thorough physical therapy

Lumbar Raadiculopathy: A Case Study
The claimant is a 45–year–old female who sustained a work–related injury on 11/25/2016 while working as a social worker. She stated that she was
backing out of a parking space when her vehicle collided with another car that was backing out of a space across from her. On an impact, she was
jerked forward and back.
On 03/16/2017, the claimant presented with a constant low back pain, worse on the right side than the left, radiating into the left leg and left foot. She
had needle EMG and nerve conduction velocity studies of the bilateral lower extremities to evaluate her lumbar radiculopathy. The studies showed
findings compatible with mild bilateral L5 radiculopathies and a left S1 radiculopathy.
On 07/17/2017, the claimant presented with low ... Show more content on Helpwriting.net ...
It was noted that she had failed ESI and physical therapy. Her surgical consultation did not go well. A radiofrequency ablation was recommended.
On 12/08/2017, the claimant had low back pain with radiation to the bilateral lower extremities. She reported numbness and weakness. It was noted that
physical therapy aggravated the symptoms. Objective findings showed tenderness in the lumbar spine with pain at the terminal range of motion.
On 12/19/2017, the claimant presented with lumbar pain. She had continued constant nagging pain with radicular pain in the left lower extremity. She
had weakness and numbness. In 2012, she underwent L4–S1 fusion. She had lumbar medial branch block in 04/2017, which helped with the axial low
back pain by more than 50%, but the radicular pain becomes severe. She stated that the previous bilateral L5 and left S1 selective nerve root block
on 06/21/2017 provided 100% pain relief for 3 days before the pain gradually returned. She also had epidural steroid injection and trigger point
injection, which did not help with the pain. The alleviating factors include medication, rest, heat, and TENS unit. The previous physical therapy and
chiropractic care had helped significantly. Objective findings showed positive straight leg raise test on the left with tenderness in the left lower lumbar
area and bilateral

The Naegleria Fowleri Amoeba
Introduction
The Naegleria fowleri amoeba resides in lakes, rivers, thermal springs, dirty swimming pool and sometimes soil. The amoebas thrive during the summer
months due to the increase of temperature(Shakoor, Beg, and Mahmood 258). Naegleria amoeba infects and targets brain tissue of the central nervous
system and the neuromuscular system. The central nervous system is responsible for integrating and responding to neural signals. The nervous system
and muscles in the body work together to permit movement called the neuromuscular system. The brain is the main control for integrating sensory
neurons and coordinating body functions: voluntary and involuntary. When needed to move a body part, a message is sent to the afferent sensory
neurons, which go through the brain and into the spinal cord where the efferent motor neurons send an electrical signal to trigger the muscle to
contract. Errors such as sliding of the actin and myosin filaments or failure to release neurotransmitters from the neuron can happen. The infection
causes primary amebic meningoencephalitis (PAM) (Shakoor, Beg, and Mahmood 258).. It cannot be contracted by person–to–person, or by drinking
contaminated water. The amoeba enters the body via nose by infected water and/or dust and penetrates the cribriform plate(Shenoy, Wilson, and
Prashanth [Page 309]). It travels to the brain by the nerves that transmit olfactory senses and causes PAM. It causes brain tissue damage and
inflammation of the brain. The

Lumbar Tissue: A Case Study
DOI: 2/17/2014. Patient is a 55–year–old female cashier who felt pain on the left side of lower back and left foot due to walking incorrectly due to a
previous work injury. The patient is subsequently diagnosed with postlaminectomy syndrome, not elsewhere classified; degenerative disc disease,
lower back; arthropathy of lumbar facet; and low back pain. MRI of the lumbar spine without contrast dated 1/4/16 (no official report) revealed
posterior fusion at L4–5 with right L5 laminotomy defect; and mild degenerative disc disease at L3–4, there is moderate narrowing of the L3 neural
foramina bilaterally. As per office notes dated 7/6/16, the patient presents for ongoing evaluation and medication refill. He rates his pain as 9. His pain
is located

Lumbar Discomfort Case Study
DOI: 02/17/2006. Patient is a 41–year–old male general laborer who sustained a work–related injury to his low back as a result of lifting fire hydrants
all day. Per medical report dated 8/22/2016, it was noted that per "Controlled Substance Utilization Review and Evaluation System (CURES) report,"
he is taking morphine extended release (ER) 60 mg one tablet twice a day; Soma 350 mg one tablet three times a day; and Norco 10/325 mg one
tablet 5 times per day. Urine drug screen obtained on 09/22/16 showed positive for hydrocodone, hydromorphone, norhydrocodone, acetaminophen,
meprobamate, tramadol and desmethyltramadol. Based on the medical report dated 12/13/16, the patient presents for follow–up. Lumbar discomfort is
described as sharp, aching, burning, shooting, severe and continuous, comes and goes, discomfort, pain, random, varying with activity, increasing with
movement, tightness, and throbbing. It is rated as 9/10 without medications and 6/10 with medications. The symptoms are aggravated by changing
positions, lifting, pulling, pushing, carrying, sitting, twisting,... Show more content on Helpwriting.net ...
Pain/tenderness is noted at the thoraco–lumbar, lower thoracic/lumbar, upper/lower lumbar, lumbo–sacral and sacral. Moderate muscle spasms are
demonstrated in the following areas: bilateral lumbar, bilateral sacroiliac, sacral, bilateral posterior pelvis/hip, and bilateral buttocks. Patient was
diagnosed with lumbar pain. IW will follow up in one month. Patient will receive a written prescription for Soma 350mg 1 tablet three times daily #90,
Morphine extended release 60mg 1 tablet twice daily #60 and Norco 10/325mg 1 tablet 5x a day as needed for breakthrough pain #150. Consult for the
low back is requested. Patient has been previously certified with 45 Tablets of Soma 350 mg, 75 Tablets of Norco 10/325 mg and 30 Tablets of
Morphine ER 60 mg on 09/01/16 (Review

Case Study: Lumbar Region Pain
This is a 51–year–old female with an 11/4/2013 date of injury, when she slipped and fell on a wet floor landing on her buttocks. DIAGNOSIS:
Lumbar Region Pain 01/04/15 Note indicated a request for authorization for Neurodiagnostic Neuromonitoring for the surgery, which sis scheduled on
01/06/15. The procedure codes that will be done include: 95941– Intraoperative Monitoring 95938 – Upper & Lower SSEP 95870 – EMG 1 extremity
(4 muscles or less) 95927 – Cortical SSEP4 95861 – EMG2 Extremity (5 muscles or more) 51785 – S–EMG (Anal Sphincter) 95937 – Train of four
95813 – EEG /Non Intracranial 10/30/15 Medical Evaluation reported neck, low back, and left sacroiliac pain. Physical examination of the lumbar
spine revealed decreased ROM on... Show more content on Helpwriting.net ...
Pain was rated 7/10 in severity. Physical examination revealed decreased lumbar range of motion in forward flexion due to pain. Gait was antalgic. She
had difficulty with heel walk and toe walk. SLR was positive on the left. Motor exam revealed weakness 4/5 of the extensor hallucis longus and tibialis
anterior muscles on the left. Reflex testing was normal. Sensory examination revealed hypoesthetic region over the left L5 distribution to pinprick and
light touch. Current medications included Gabapentin, Tramadol, Methocarbamol, Cymbalta and Synthroid. Treatment plan discussed includes lumbar
laminectomy, discectomy, foraminotomy and partial facetectomy at L4–5, preoperative medical clearance and post–operative bracing. 11/13/14 MRI of
the lumbar spine showed 4mm left paracentral and foraminal disc protrusion at L4–5, which mildly impinges upon the thecal sac and the proximal left
L5 nerve root. The disc protrusion also moderately narrows the left foramen and lateral recess. There was also a 2mm posterior central disc protrusion
at L5–S1. A 2mm disc bulge at L2–3 was seen. There was a mild degenerative facet and ligament flava hypertrophy at L4–5 and

Lumbar Strain Case Studies
DOI: 5/12/2015. Patient is a 57–year–old male crane operator who sustained injury when he felt pain in his lower back from moving multiple
outrigger pads weighing approximately 80 pounds each. Per OMNI, he was diagnosed with lumbar strain. He is status post lumbar laminotomy at
L3–L4 and L4–L5 on 03/01/2016 Per the PT attendance report dated 07/20/16, the patient has attended a total of 18 sessions since 04/15/16 through
06/27/16. MRI of the lumbar spine obtained on 07/27/16 showed interval posterior decompression at L3–4 and L4–5, without residual spinal canal
stenosis and mild bilateral neuroforaminal stenosis at L5–S1, change from prior. Based on the progress report dated 10/12/16 by Dr. Kahmann, the
patient presents for a postoperative

Lumbar Laminectomy Case Summary
DOI: 1/29/2012. Patient is a 34–year–old female clinical assistant who sustained a work–related injury to her back when she was transferring a patient
and felt pain in her low back and left side. She has prior history of lumbar laminectomy. She was treated conservatively with non–steroidal
anti–inflammatory drugs, physical therapy and work restrictions. Per the PT progress notes dated 10/29/14, patient has attended 21 sessions for the
back. She is status post left sacroiliac joint and left piriformis trigger point injection on 08/27/15.
Based on the medical report dated 12/16/15, the patient follows up from completion of PT. She has had a left sacroiliac (SI) joint and piriformis
trigger point injections which have provided some relief. She states that PT did help somewhat but there is increase of pain with doing the exercises.
She states she also ... Show more content on Helpwriting.net ...
She has disc herniation at L5/S1 that may also be a contributor and mimicker of her symptoms.
Recommendation was made for a left L5 transforaminal epidural steroid injection to see if this will help her pain more than the SI joint and piriformis
trigger point injections. This would be for diagnostic purposes and potential therapeutic. She would like to schedule the injections.
Requested verification from the provider's office on the indication of intravenous sedation, however, no callback was received prior to the submission
of this request to PA.
Per the AME supplemental report by Dr. Garland dated 05/21/14, the treating doctor has recommended an anterior lumbar decompression and fusion
followed by posterior fusion with instrumentation. It was opined that the IW still needed more treatment and surgery should be authorized.
Current request is for 1 Left Lumbar Transforaminal Epidural Steroid Injection at the L5 Level under IV Sedation and Fluoroscopy between 12/23
/2015 and

Lumbar Spine: A Case Study
This is a 22–year–old male with a 6/11/2015 date of injury. He reported injuring his lower back, June 11, 2015 while carrying a desk up the stairs to
the second story. DIAGNOSIS: Lumbar disc protrusion Lumbar sprain / strain 11/25/15 Progress Report described that the patient has moderate to
severe pain in his lumbar spine. The pain is 5–6/10–scale level. It is radiating, to his right leg; associated with stabbing; aching and sharp. There is
limited ROM due to pain, with stooping, bending, lifting, pushing, pulling, carrying, walking, standing, sitting, ascending and descending stairs. The
patient reported difficulties performing his ADL. The patient also reported sleeping problems. The patient is not working since is injury. The patient is
currently taking Advil 200 mg an ibuprofen. Exam of the lumbar spine revealed tenderness to palpation over the... Show more content on
Helpwriting.net ...
SLR is negative bilaterally. There is reduced ROM of the spine. The sensations were diminished over the L4 dermatome of the right lower extremity.
Treatment plan included ibuprofen, Flexeril and authorization for initial labs. Treatment to date has included medications; light duty, which is not
being accommodated by his employer, 6 sessions of PT. The request is for Labs: CBC, Hepatic Panel, CRP, Chem 8, Urinalysis, Arthritis panel,
CPK. CONCLUSION: Regarding Labs: CBC, Hepatic Panel, CRP, Chem 8, Urinalysis, Arthritis panel, CPK; the patient was prescribed ibuprofen and
Flexeril on his last visit. The provider is requesting an initial lab testing to include CBC, Hepatic panel, CRP, Chem 8, UA, Arthritis panel and CPK, in
order to make sure that the patient can safely metabolize and excrete the medications prescribed. The MTUS, ACOEM,

The Importance Of Observation On Human Development
1. Observation: A 53–year male who has spent frequent amount of time working in a warehouse which requires a lot of lifting of heavy objects and
seems to have strained his lower back and is having weakness in his right leg. In addition, the patient has a weak patellar reflex in his right leg and a
normal patellar reflex in his left leg. However, his calcaneal reflex response for both legs was normal.
2. Question: Does this man have a herniated disk in the lumbar region of his spine and if so which lumbar is herniated and how is affecting the
functioning of his legs and what we can to fix that.
3. Hypothesis: Based on his age, the strenuous lifting that he does in his job, I suspect that he has herniated Nucleus Pulposus from either L2 to L4.
The compression of the dorsal divisions of the ventral rami of his lumbar spine is causing his femoral nerve to not properly work on his right leg.
4. Prediction: I predict that he has a herniated lumbar disk on L3 or L4 caused by improper lifting and due to his increased age, which has made his
bones more brittle. Consequently, I predict he will experience some weakness in his right leg, when he is standing or trying to lift something.
Consequently, he will experience pain since the dorsal horn compressed along with the ventral horned being compressed.
5. Test: The tests we perform is an MRI of his lumbar spine, and I also want to test his skin sensations via a prick test on his leg to see if the dorsal root
ganglia of his L3 or L4 is damaged, since right now it just appears that his ventral root of his L3 or L4 is damaged since he has a muscle weakness
suggesting that the right ventral horn is being compressed by the right lumber vertebrae body.
6. Conclusion: Yes, he has a herniated disk on L3 which was confirmed by the MRI showed that he had a herniated nucleus pulposus of the L3 disc
and he had some mild sensation loss in his right leg. A herniated disk is a disk that has slipped or ruptured. Herniated discs are more common as one
gets older since the bones become more brittle overtime prone to rupture under stress such as heavy lifting. Consequently, our patient is 53 is and due
to his age, he did rupture his L3 disc due to improper lifting. The muscles

Lumbar Interval Disc Degeneration
The impact of smoking in lumbar interval disc degeneration and sciatica was also reported several times. BattiГ© et al. (1991) studied the impact of
smoking in lumbar interval disc degeneration of identical twins using magnetic resonance imaging. Results showed that the risk of lumbar interval disc
degeneration was 18% greater for smokers compared to non–smokers. Non–occupational lifting was also studied as a risk factor for herniated lumbar
intervertebral disc (Mundt et al. 1993). For this study, 287 patients with symptoms of herniated lumbar disc were involved and compared with control
subjects without back pain taking in consideration the age, sex, source of care and geographic area. Based on their data, they showed that the risk of
herniated... Show more content on Helpwriting.net ...
The first study published (Videman, et al., 1998) was involved monozygotic twins in Finns, with alleles of the TaqI and FokI polymorphism being
associated with reduced magnetic resonance imaging signals of thoracic and lumbar discs. Another more recent study which confirmed the previous
study was based on 205 Japanese volunteers and patients between age 20 and 29 years. From this study was found that Tt genotype of the TaqI
polymorphism were more frequently associated with multilevel disc disease, severe disc degeneration and disc herniation than the TT genotype
(Kawaguchi et al., 2002). In addition, influence of TaqI polymorphism to lumbar degenerative disc disease verified in Chinese population (Cheung, et
al., 2006). The fact that replication of TaqI polymorphism was appeared in three different populations makes VDR as the most robust of genes
associated with disc degeneration disease. The reason for this is not clear but a possible explanation is based on the fact that the polymorphism can
affect the receptor level and function of vitamin D. Based on the fact that vitamin D influence the sulphate metabolism which is important for
sulphation of glycosaminoglycans (GAGs) during proteoglycan synthesis, the latter can lead to changes in the structural characteristic of the
extracellular matrix in the intervertebral

Analysis Of A Functional Capacity Analysis
All available documentation submitted for this claim has been reviewed from the perspective of Internal Medicine. The claimant is a female (DOB
07/08/1978) who is claiming disability from 07/10/2017 to 07/31/2017. The claimant works as a Senior Operations Production Coordinator, with job
demands such as continuous sitting. The basic description of work was performed via a computer daily.
The claimant underwent medial branch block on C3–C6 bilaterally on 09/30/2016, followed by radiofrequency ablation on 12/23/2016. The claimant
underwent transforaminal epidural steroid injection bilaterally on L4–L5 and L5–S1 on 01/06/2017, 02/07/2017, 03/10/2017, 04/25/2017,
A Functional Capacity Evaluation (FCE) report dated 05/05/2017 was completed ... Show more content on Helpwriting.net ...
The claimant was diagnosed with radiculopathy in the lumbosacral region.
SOAP note dated 06/23/2017 stated that the claimant complained of cervical, thoracis and lumbar spine pain. The claimant also had swelling related to
neuropathy. The claimant's blood pressure was 141/105. The physical examination revealed significant muscle spasm with moderately reduced and
painful range of motion in the cervical spine, as well asn neck pain. There was positive cervical dystonia and positive facet loading as well.
Examination of the back revealed significant muscle spasm and moderate pain with range of motion, positive bilateral hip and sacroiliac joint
tenderness. There was decreased mobility, decreased lumbar spine extension and positive facet loading test. There was positive bilateral L5
radiculopathy. There was numbness in the lower extremities and non–pitting edema in the bilateral legs. The claimant was diagnosed with cervical
spine pain, chronic lower back pain, chronic pain syndrome, lumbar spine radiculopathy and radiculitis nad cervical sponsylosis without myelopathy.
The treatment plan included continuing with chiropractic care, physical therapy, LSO, and medication management.
Blood glucose level dated 06/30/2017 was elevated at 119. Chest x–ray was stable with appearance of focal consolidation in the mid right lung,
suggestive of pneumonia. CT of the cehst, abdomen, and pelvis revealed a large consolidation within the posterior right upper lobe with air

Lumbar Radiculopathy
Overview of lumbar radiculopathy
Lumbar radiculopathy (sciatica)and other types of back pain is one of the most frequent and essential spinal condition that a physical therapist
commonly treats. Lumbar radiculopathy is a sciatic nerve root irritation or compression at the lower spine (Fuller & Goodman, 2015). A person with
sciatica experiences a sudden pain, tingling sensation and weakness from the lower back radiating through the buttocks, groin and all the way own
to the leg and feet depending on the affected nerve root irritation, usually from L1 to S1 ( Ropper & Zafonte, 2015). Sciatica evolves between the age
of forty to sixty years old and commonly occurs more in male as compared to female (Fuller & Goodman, 2015).The ... Show more content on
Helpwriting.net ...
(3) spondylolishesis is the lumbar slippage of the vertebra between L4–L5 and L5 and S1 which causes the compression of the spinal nerves 4)
degenerative joint disease related to aging is also responsible for the cause of sciatica, there is a malformation involvement in the spine and
dehydration resulting to disc herniation and severe inflammation in the vertebral bodies causing the compression and irritation of the spinal nerve
roots 4) degenerative joint disease related to aging is also responsible for the cause of sciatica . Sciatica evolves between the age of forty to sixty years
old and commonly occurs more in male as compared to female (Fuller & Goodman, 2015). Also, genetic cause also plays a significant role in etiology
aside from infection, the vast amount of load of the vertebral column causing the protuberance of the disc(Fuller & Goodman, 2015). Moreover,
malignancy or arthritic spine within the vertebra or trauma implicates the cause of sciatic nerve irritation or compression (Fuller & Goodman,

Lumbar Disc Herniation Essay
Human race has been affected by back pain and leg pain since the beginning of history. Even though there are various pathological conditions which
present as back pain, most common condition giving rise to back pain is LUMBAR DISC HERNIATION. Lumbar Disc Herniation is one of the
commonest problems in adults. At their productive age this problem is debilitating and if timely intervention is not made the outcome is quiet
disabling. Lumbar disc herniation in the past have been treated successfully with both conservative and surgical modalities. Various studies in the past
have proved both these modalities, conservative and surgical treatment to give a good relief of symptoms. Weber et al in his study compared the long
term outcome of disc herniation treated... Show more content on Helpwriting.net ...
Newer techniques have evolved since then. With the advent of advanced instrumentation and newer techniques the surgical treatment for disc prolapse
has changed ever since then. Recent advancement like micro–discectomy and endoscopic discectomy are becoming more popular in recent times.
These are minimally invasive surgeries and less morbid procedures compared to regular fenestration discectomy. However the cost factor and need for
advanced instrumentation for these procedures has been a main draw back. Hence fenestration Discectomy is still the regularly been performed widely.
In this study the functional outcome of fenestration discectomy for a single level lumbar disc herniation with unilateral radiculopathy is assessed using
Japanese Orthopaedic Association scoring system. The common levels of L4–L5 and L5–S1 have been chosen for the study. Both these levels have
significant anatomical as well as bio–mechanical differences. Hence the clinical presentations in the two areas are chosen for the study and the
outcome of the management is being

Lumbar Vertebral Column, An Amazing Part Of The Human Body
Lumbar Vertebral Fracture
The Vertebral column is an amazing part of the human body. It is made up of many different pieces that all fit together to make something that keeps
the body up right, allows movement, supports weight and protects the spinal cord. There are four different segments of the spinal cord. One of those
segments is called the lumbar region. The lumbar region consists of 5 vertebrae that make up the lower back (Lippert, 2011). The lumbar region
supports most of the body weight and allows movement. People often do not realize how important the vertebral column is until it is already injured.
Injury to the lumbar region can be caused from a vertebral fracture and can be very painful to ones lower back.
Etiology
Lumbar Vertebral Fractures, also known as a compression fractures are caused from a variety of reasons. Some of the causes can be from high impact
trauma or diseases. Some vertebral fractures are causes by high impact trauma occurring in motor vehicle accidents, long distance falls and sports
injuries. The diseases that can cause compression fractures are osteoporosis and spinal tumors. Compression fractures can occur from bone
insufficiency as well as falls, lifting and trunk motions, such as flexion, extension, lateral bending and rotation (American Academy of Orthopedic
Surgeons [AAOS], 2015). Osteoporosis is the main cause of compression fractures. Depending on the severity of the fracture signs and symptoms
include severe lower back pain,

Lumbar Neck Case Studies
DOI: 8/10/2016. Patient is a 38–year–old female retail specialist who sustained a work–related injury to her back when she was moving boxes.
MRI of the lumbar spine dated 08/31/16 showed a large broad–based herniation at the L4–5 disc level which is predominantly right–sided, although
extends to the left lateral canal as well. There is central canal stenosis. There is a left–sided herniation laterally at the canal and at the proximal left
foramen at the L5–S1 level. There is likely a transitional segment. If surgery is considered, anteroposterior views of the thoracic and lumbar spine are
recommended. Changes suggesting prominent spasm are noted.
As per the initial consultation report on 11/7/16, the patient's pain has progressively worsened ... Show more content on Helpwriting.net ...
Power testing is limited in the right external hallucis longus at 4/5.
Of note, MRI of the lumbar spine reveals right disc herniation at L4–5, left disc herniation at L5–S1.
Patient was diagnosed with lumbar radiculitis with possible radiculopathy. The IW will undergo a series of two lumbar epidural injections with
epidurography and fluoroscopic guidance. This is diagnostic and potentially therapeutic. If the IW fails to achieve any response to axial pain, lumbar
facet injections may be considered, as well as disc decompression, provocative discography.
Treatment plan also includes medications, physical therapy and chiropractic manipulation therapy.
Per affiliated reviews, patient has been denied with 1 Series of 2 Lumbar Epidural Steroid Injections with Epidurography and Fluoroscopic Guidance
on 11/28/16 (Review 284147).
Are the request for 1 Lumbar Epidural Steroid Injection at Bilateral L4/L5 Levels with Fluoroscopic Guidance; and 1 Lumbar Epidural Steroid
Injection at Bilateral L4/L5 Levels with Epidurogram between 12/21/2016 and 2/19/2017 medically

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