848 - Lumbar post-laminectomy syndrome due to loose screws and hardware migration in the context of senile osteoporosis: a case report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

TP

Tyler Petersen, n/a

Medical Student
Wayne State University School of medicine
Detroit, Michigan, United States

Co-Author(s)

JE

Jeff Elliott, MD

Resident Physician
Detroit Medical Center - Wayne State University
detroit, Michigan, United States
DR

David Rustom, MD

Physician
Detroit Medical Center - Rehab Institute of Michigan
Detroit, Michigan, United States

Case Diagnosis: Lumbar post laminectomy syndrome, traumatic spondylopathy, and vertebral pathological fracture of L3/4/5/S1 from senile osteoporosis resulting in loose screws and hardware migration

Case Description: Patient is a 75-year-old woman with past medical history of osteoporosis, lumbar radiculopathy, and spondylolisthesis who underwent lumbar L3-S1 fusion with decompression. Postoperatively, she experienced worsening bilateral lower extremity weakness and urinary retention resulting in drain placement. She completed 4 weeks of inpatient rehabilitation, which was complicated by a fall. Throughout her rehabilitation she experienced incessant pain. Following up in the outpatient pain clinic, patient endorsed severe pain radiating to both legs associated with paresthesias and bilateral hip flexor weakness. Repeat imaging of the lumbar spine showed migration of L3/4 Oblique Lateral Interbody Fusion (OLIF) cage and L4/5 anterior plate. Patient then underwent cement augmentation of L3-S1 screws and revised L3/4 interbody fusion. Following the operation, the patient completed 10 more days of inpatient rehabilitation and followed up for outpatient physical therapy. Patient’s bladder incontinence and weakness resolved, and her pain improved as a result of this operation.

Discussions: Hardware migration in the context of senile osteoporosis causing post laminectomy syndrome represents a unique pathology of post laminectomy syndrome. It is rarely seen in patients undergoing this operation. In patients with increasing, unrelenting pain with severe neurological deficits, it is important to keep in mind this etiology. Additionally, it is unknown to what degree this patient’s osteoporosis contributed to the hardware complication. This represents a relevant medical diagnosis contributing to etiology in assessing pain and neurological deficits following this surgery.

Conclusions: This case represents a unique presentation of post laminectomy syndrome. In older patients, as well as those with osteoporosis, hardware migration is an important etiology to keep in mind during assessment.