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Case Study: Intractable Lower Back Pain

Dr. Ahmad Latefi

A 59-year-old female was referred to us in August 2012 because of worsening intractable lower back pain with radiation to her left lower extremity. She stated that she had undergone back surgery 30 years earlier for unidentified issues and had subsequently received all forms of conservative care including chiropractic, physical therapy and epidural steroid injections in search of relief with minimal to no effect. She also stated that she was diagnosed with curvature of the spine when she was younger.

On physical examination in the office, she was found to have a forward posture with a complete absence of normal lumbar lordosis. Her motor, sensory and cerebellar responses were within the normal range and her reflexes and gait were found to be normal and symmetric. The patient’s previous MRI studies were also examined and revealed a sagittal deformity as well as the previously noted flat back. In order to determine the cause of the back pain and develop treatment, a scoliosis series of x-rays were subsequently ordered. The resulting preoperative diagnosis was fixed sharp kyphotic deformity, sagittal imbalance and dextroscoliosis. Spinal instrumentation and fusion were deemed the appropriate means to achieve spinal alignment and eradicate pain due to nerve impingement and the corrective surgeries were scheduled.

The patient, a teacher, was able to return to the classroom after recovery. She is able to stand straight and to look straight ahead. Her pain is significantly improved with the result that she no longer needs narcotic pain medications.

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Case Study: Intractable Lower Back Pain

(Left) Preoperative and (right) postoperative correction of a kyphotic deformity