Sonia Chansiya, DO
Resident Physician
Nassau University Medical Center
Bethpage, New York, United States
Jenzel Espares, DO
Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
Ajendra S. Sohal, MD
Attending Physician
Nassau University Medical Center
East Meadow, New York, United States
A 71-year-old male with a history of lumbar stenosis underwent L4 pedicle subtraction osteotomy, L1-L2 decompression, and T10-pelvis spinal fusion. His recovery was complicated by Failed Back Surgery Syndrome (FBSS). He subsequently needed re-instrumentation and further fusion, which led to significant intraoperative blood loss. Post-operatively, due to severe limitations in mobility, gait, balance, and activities of daily living (ADLs), the patient received acute rehabilitation services including physical therapy (PT) and occupational therapy (OT), followed by outpatient PT. The patient reported persistent low back pain radiating to both lower extremities, accompanied by moderate pain and weakness in the right lower extremity, especially affecting the hip flexors. These symptoms suggest a post-surgical development of femoral nerve palsy (FNP) following FBSS.
Discussions:
FNP is an uncommon yet significant complication following FBSS. It can arise from various factors including trauma during surgery, manipulation, or bleeding into the iliopsoas muscle, which is often involved in such procedures. In our patient, despite ongoing physical therapy, the weakness in the right lower extremity persisted highlighting the need for targeted interventions. The primary focus of PT in our patient has been to manage low back pain and strengthen the quadriceps muscle to improve functional independence. The patient ambulates with a single-axis cane and experiences insomnia resistant to melatonin. Recent adjustments to gabapentin dosage have improved sleep and provided some pain relief. An electromyography (EMG) study confirmed right femoral nerve neuropathy with a mixed axonal and demyelinating polyneuropathy pattern.
Conclusions:
FBSS presents considerable challenges owing to its unclear etiology and the absence of definitive treatments. A comprehensive, multidisciplinary approach is essential for managing this complex condition. Including treatments such as gabapentin, as well as targeted PT interventions to effectively address the multifaceted issues associated with FBSS and its complications, improving overall patient outcomes.
