Eubanks E. James, MD, MS
Assistant Professor, Department of Orthopaedics and Physical Medicine and Rehabilitation
Medical University of South Carolina; University of Pittsburgh Medical Center
Charleston, South Carolina, United States
Andy Hu, BS
Medical Student
Medical University of South Carolina (MUSC)
Charleson, South Carolina, United States
Swathi Muttana, MD
Resident Physician
Geisenger
Mifflintown, Pennsylvania, United States
Below Knee Amputation
Lumbar Spinal Stenosis
Vertebral Compression Fracture
Case Description: A 68-year-old male with insulin-dependent diabetes mellitus, renal transplant, right transmetatarsal and left below knee amputation requiring the use of a Rollator was referred to an outpatient PM&R spine clinic for low back and right lower extremity pain. He reported 9 falls in less than 12 months on brick steps required to enter his apartment. He reported the need for a ramp to his landlord who refused. Upon examination by a spine physiatrist, the patient was diagnosed with L5 vertebral compression fracture on x-ray, lumbar spinal stenosis with neurogenic claudication, and poor vision. In addition to balance deficits, his left prosthetic leg was found to be improperly fitting during gait evaluation.
Discussions: Upon physiatric evaluation, a comprehensive treatment plan was developed. In the setting of multiple falls, x-ray evidence of vertebral compression fracture and history and exam evidence of spinal stenosis, a lumbar spine MRI was ordered. Physical therapy was prescribed for generalized deconditioning, gait training and balance dysfunction, and the patient’s right lower extremity pain was treated with an L5 transforaminal epidural steroid injection. A new prescription was written for a left leg prosthesis and the patient was sent to optometry due to poor vision using old glasses. It was determined that the patient required a ramp to enter his apartment safely, and a letter was written to the patient’s landlord outlining this need with education about the federal Fair Housing Act, and a ramp was built in 48 hours.
Conclusions: Physiatrists have a unique opportunity and obligation to improve the quality of the lives of their patients by leveraging the full scope of our rehabilitative training, including in the outpatient spine setting. Doing so highlights the niche they serve within the health care system as experts in the optimization of function.
