A Chiropractor Can Help Failed Back Surgery Syndrome

From Dr. Natalie Meiri’s Clinical Pearl Stories:

 A Chiropractor Can Help Failed Back Surgery Syndrome 

This was a 87 year old patient who presented to my office with low back pain and pain in both legs. To be HIPAA compliant, I will call him Henry instead of his real name.   Henry had  a laminectomy nearly 10 years ago on his low back. A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina, which is the roof of the spinal canal. Also known as decompression surgery, a laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves. It is a major spine operation with residual scar tissue and may result in Failed Back Surgery Syndrome (FBSS) which was the case with Henry. FBSS patients  have new or persistent pain after spinal surgery for back or leg pain.

Henry had the laminectomy on his L4-L5 vertebra due to a dropped foot.  Although, his dropped foot improved after the surgery, he had pain in his low back and legs which he didn’t have prior to the surgery.  Foot Drop is a term used to describe difficulty lifting the front part of the foot. Common causes are L4-L5 radiculopathy (nerve compression), caused by either a herniated disc, degenerative disc and/or foraminal spinal stenosis, and peroneal peripheral neuropathy in the leg.

Henry’s Medical History

Henry was active in his younger years playing tennis and golf almost every day.  In addition to the laminectomy, Henry had a left total knee replacement a few years ago. He started going to the gym since his knee replacement, but his back and leg pain kept getting worse.  Henry was on numerous drugs for the pain and for his high blood pressure. 

His internist had ordered a doppler ultrasound to rule out a circulation problem in his legs. Henry had tried acupuncture without any success.  Furthermore, the physical therapy treatments at home seemed to help some, but not enough.  Therefore, Henry came to see me. Henry wanted to feel better and go back to the gym.

Henry’s Exam and Imaging

Upon examination, Henry had positive tests for both hips, right knee, both ankles, mid and low back.  X-rays taken in my office showed osteoarthritis (wear and tear arthritis) in his thoracic spine (mid back), lumbar spine (low back), hips, right knee and both ankles.  I would send Henry for further imaging (i.e. magnetic resonance imaging, MRI) or a electromyography (EMG) and nerve conduction study (NCS) if there wasn’t any improvement within 12 visits.