Dear friends,
Few days back i submitted a case history of one of my paitent in severe
pain not responding to the any conventional treatment of the for the
opinion of the house regarding any conservative management
of this case.Please let me know
- should we stop ATT,anttuberculosis drugs
- should any manupulation tried
- out of three conditions,stenosis,discs.Ant comression #
which is responsible for pain
- if atall the surger is to be attempted what should be the
aproach
hence I once again submit this case for your valuable opnion
thanks
Sr.S.C.Sood
HELLO
EVERYBODY!
Working with back pain is strange ,sometimes a
simple looking case is tied and sometimes a difficult case with migrating
pain and paresthesia responds and like a magic and it is
gone for good.
I invite my friends to send their expert opinion in following
case:
On one fine morning about a year back 25yrs old
Policeman reported at my office with severe back pain in L4/L5 area
,localized ,local tenderness on deep palpation was present,no refered pain
or paresthesia was present .At that time he gave no history
of trauma or fever.However after repeated
questioning he agreed to have fallen from a tree during an commando
operationmany years back. upon X-ray examination anterior
compression fracture of L4 vertebra was seenI advised him LS corset ,rest
,NSAIDS,muscle relaxant,interferential therapy & Short wave Diathermy
was added.After many months on physiotherapy & Chemotherapy and rest he
only showed aggravation of pain nothing seems to help.His blood
investigations were within normal limit,but ESR was Raised Mtx weekly
postiveSo far he was in extreme pain not drug even Opoids derivatives
antidepressants seemed to help,than I put him on anti tuberculosis
drugsfive months
back.Still he showed no improvement.Somwhere in between some doctor gave him
Cortisone injection,he even weent to a quack for some manipulations(,as in
India there are no qualified manual-therapist,) In sheer desperation
he even went to a tantaric i.e black magic to shun away any evil
spirit.after going around everywhere he retained back to me meanwhile he
continued ATT.He is unable to sit,walks with kyphosis.and pain is
constant.He is not willing to undergo surgery.Then I ordered MRI;it shows
- Canal stenosis both bony
and secondary type at L3,L4,L5 levels with sagital and lateral canal
compromise.
- Postero-central disc
protusion L4-5,L5-S1 Discs.
- Old Compression fracture
L4.
- Nointraspinal mass or
pre/para vertebral mass is seen
What conservative treatment if their is
any could be attempted?Shall he continue ATT drugs.?waiting for your valued
opnion.
Thanking you,
Dr.S.C.Sood
Orthopaedic Surgeon
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