1. Whose Patient is it Anyways?
PLENARY SESSION C: CATEGORIZING, DIAGNOSING AND MANAGING THE LUMBAR SPINE
Whose Patient is it Anyways?
Case History Panel

2. Moderator – Dr. Gil Faclier MD
Panelists – Dr. Eric Massicotte - MD
– Dr. Michael Gofeld MD
– Anja Franz RPT
– Dr. Ed Cambridge DC
– Darryl Yardley RPT

3. Treatment of Unilateral Radiating Leg Pain
Case History #1
Treatment of Unilateral Radiating Leg Pain

4. Treatment of Unilateral Radiating Leg Pain
Radicular pain can be an extremely painful condition that is difficult to manage. Using a case history approach this session looks at differential diagnosis, indications for tests, medication, injection, surgery and therapy.

5. Treatment of Unilateral Radiating Leg Pain
Case History #1
Treatment of Unilateral Radiating Leg Pain
34 year old male. 
2014 back surgery L4-5 microdiscectomy. 
Did well post-op however recurrent leg pain started within three months. 

6. Treatment of Unilateral Radiating Leg Pain
Case History #1
Treatment of Unilateral Radiating Leg Pain
Repeat MRI done in 2014 showed herniation at L4-5. 
The patient declined surgical RX. 
3 years later presented to assessor with intermittent radiating leg pain. 

7. Treatment of Unilateral Radiating Leg Pain
Case History #1
Treatment of Unilateral Radiating Leg Pain
Can be pain free with a minimum of 1 hour per day of stretching. 
If he doesn’t stretch pain is 8/10 and needs Percoset. 

8. Treatment of Unilateral Radiating Leg Pain
Case History #1
Treatment of Unilateral Radiating Leg Pain
Panel Questions

9. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #2
Differential Diagnosis Low Back, Buttock and Groin Pain

10. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #2
Differential Diagnosis Low Back, Buttock and Groin Pain
Determining whether pain is referred from the back, buttock, SI joint, hip bursa or hip joint can be difficult. Using a case history approach this session looks at which tests and examinations are most helpful in teasing out the source of pain.

11. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #2
Differential Diagnosis Low Back, Buttock and Groin Pain
30 y.o. female with pain right buttock, lateral hip and groin. 
Has had intermittent low back and buttock pain beginning in her 20’s. 

12. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #2
Differential Diagnosis Low Back, Buttock and Groin Pain
She is now a new mom with pain beginning in 3rd trimester in pregnancy however pain is getting worse. 
Beginning to radiate down the right leg.
Can’t lie on her right side.  Finding it hard to walk.  Better when she sits. 

13. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #2
Differential Diagnosis Low Back, Buttock and Groin Pain
Lumbar X-ray – mild degenerative changes L4-5, L5-S1
SI Joint X-ray – Mild to moderate degenerative changes with no definite erosions
EMG – No significant findings . 

14. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #2
Differential Diagnosis Low Back, Buttock and Groin Pain
Panel Questions

15. Differential Diagnosis and Treatment of Bilateral Radiating Leg pain
Case History #3
Differential Diagnosis and Treatment of Bilateral Radiating Leg pain

16. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #3
Differential Diagnosis Low Back, Buttock and Groin Pain
50 year old male experiencing leg pain with walking. 
Can walk 1-2 blocks before legs feel heavy and painful. 
Periodically if he walks further the pain gets better and he can keep walking. 

17. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #3
Differential Diagnosis Low Back, Buttock and Groin Pain
MRI shows a large central disc bulge at L5-S1 and a congenitally small canal. 
Mild-moderate L5-S1 joint arthropathy.

18. Differential Diagnosis Low Back, Buttock and Groin Pain
Case History #3
Differential Diagnosis Low Back, Buttock and Groin Pain
Panel Questions