Latest Case Presentation

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Latest Case Presentation

History

A 22 year old male with a two year history of low back pain and intermittent right leg pain sustained an acute worsening of his right leg pain 12 days prior to evaluation. He proportionalized his pain to 5% back and 95% leg pain. He complained of a new onset of weakness, tingling, and constant numbness. The pain and numbness radiated down the posterolateral leg to the dorsum of the right foot. He was unable to bear weight on the right leg and was using a walking pole for support. He was unable to sleep supine and had to sleep in a recliner to minimize the pain. Sitting provided some relief. He had no bowel or bladder incontinence.

Physical Exam

Physical exam revealed an antalgic gait, limited lumbar extension to 10 degrees, tenderness in the right sciatic notch, positive straight leg raising (SLR) and Lasegue’s tests, positive contralateral SLR, 2+ bilateral patella and Achilles deep tendon reflexes, decreased sensation to light touch over the dorsum of the right foot and to a lesser extent the lateral border of the foot, and weakness. The right sided weakness

was graded as 4/5 EHL. (5/5 is full strength). This was consistent with severe radiculopathy at L5 > L4 and S1.

Imaging

MRI revealed a large right paracentral/foraminal extruded herniated nucleus pulposus causing compression of both the exiting and traversing nerve roots

Treatment

Urgent Intervention was recommended due to the acute onset and non- progressive neurologic deficits followed by physiotherapy. After a full discussion of his risks, benefits, and alternatives the patient elected to undergo OZONE NEUCLEOLYSIS with Right Transforaminal Epidural Injection with programmed Indoor Physiotherpy for 7 days. The patient experienced over 80% pain relief immediately at 2nd day after Injection. He had some mild numbness over the right L5 distribution and. this completely resolved by 4 weeks Home Based Rehabilitation Program. After 4 weeks Comprehensive Rehabilitation Program- MRI revealed excellent herniation removal without any retained fragments. The patient’s acute pain resolved

within 24 hours and he had no pain at all by 4 weeks. His weakness improved to full 5/5 strength.

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