•Lower low back pain (4-8 with standing, no pain with supine position)
•3 prior operations at L4-5 without improvement
•Also has pain in (3-7) midthoracic spine with standing
•Relieved by lying down
•Note there is no percentage of LBP vs leg pain
Patient has had 3 prior surgeries on lower back with continued LBP
•Had an initial decompression but unplanned fusion at L4-5 after removal of meningioma
•Second surgery was for pseudoarthrosis (ALIF)
•Third surgery was to “decompress the scar” causing LBP (ineffective)
•What is really causing his lower back pain?
What is his lumbar lordosis?
(97 degrees)
What is normal?
What Causes Hyperlordosis?
•Lumbar hyperlordosis is typically a compensatory mechanism caused by hyperkyphosis in thoracic spine (or hip contractures)
•This is 75 degree kyphosis-what’s normal?
•Prolonged exposure to lumbar hyperlordosis causes facet imbrication and degeneration
•He has significant degenerative facet disease
•His thoracic pain is caused by both load on degenerative discs and overload extensor muscle pain
