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.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
