Patient has had 3 prior surgeries on lower back with continued lower back pain. Pain is relieved by lying down.

1. Clinical Case Studies

2. What Causes This Pattern?
• Lower low back pain (4-8
with standing, no pain
with supine position)
• 3 prior operations at L4-5
without improvement
• Also has pain in (3-7)
midthoracic spine with
standing
• Relieved by lying down
• Note there is no
percentage of LBP vs leg
pain

3. Patient has had 3 prior surgeries on
lower back with continued LBP
• Had an initial
decompression but
unplanned fusion at L4-5
after removal of
meningioma
• Second surgery was for
pseudoarthrosis (ALIF)
• Third surgery was to
“decompress the scar”
causing LBP (ineffective)
• What is really causing his
lower back pain?

4. What is his lumbar lordosis?
(97 degrees)
What is normal?

5. What Causes
Hyperlordosis?
• Lumbar hyperlordosis is typically a
compensatory mechanism caused
by hyperkyphosis in thoracic spine
(or hip contractures)
• This is 75 degree kyphosis-what’s
normal?
• Prolonged exposure to lumbar
hyperlordosis causes facet
imbrication and degeneration
• He has significant degenerative
facet disease
• His thoracic pain is caused by both
load on degenerative discs and
overload extensor muscle pain

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