This case involves a 38-year-old female patient who underwent a laminectomy with disc fusion to remove the back of 4 vertebrae. As advised, she started physical therapy in the weeks following the surgery. As part of the therapy regimen, the patient received what she described as an aggressive massage. Immediately afterward, she had difficulty standing due to pain and subsequently pain while walking. Following this aggressive treatment, the patient developed symptoms of sciatica in her left leg as well as a left foot drop, which led her to see her neurosurgeon. Lumbar X-rays showed a fractured cortical screw at one of the vertebrae which was not present in the prior Lumbar X-rays taken before the surgery. CT and MRI imaging confirmed the fracture cortical screw and a new disc herniation with nerve impingement. The patient underwent revision surgery in the same month. The second spine surgery relieved some of the patient’s sciatica symptoms. However, the patient required a daily brace as well as assistance from a walker to ambulate.
Question(s) For Expert Witness
- 1. How often do you treat patients with lumbar laminectomy?
- 2. What are the standard precautions that should be taken during physical therapy for a patient with recent lumbar spine surgery?
Expert Witness Response E-173771
I treat patients with lumbar laminectomy 12-15 times a year, on average. You absolutely have to obtain the patient’s surgical history prior to initiating a physical therapy session. Precautions that should be taken for a patient with recent lumbar spine surgery depends on the type of lumbar spine surgery performed. The surgeon should have provided the therapist with any indicated precautions, and ideally a surgical rehab protocol as well. In the absence of that, there are numerous researched based rehab protocols available for the therapist to use. In my experience, most clinics have them available either as hard copies within the facility or online and available for the therapists to access. Should the surgeon have additional precautions, the precautions should be listed on the referral. As a rule, I would not perform any manual therapy on the patient for a minimum of 12 weeks, especially if the surgical site involves hardware. Gentle soft tissue work may progress after the surgical incisions have closed (typically 12-14 days) in an effort to minimize scar tissue formation.