USAF HPSP pitfalls
After spending 13 years enlisted, 8 of it AD, in aviation maintenance I entered a US MD program on an HPSP scholarship. During April of my second year I was diagnosed with NHL after presenting with back pain and pending paraplegia. I underwent an emergent laminectomy followed by EBRT and chemotherapy. January of my fourth year I was notified that my scholarship was being terminated for being unfit to serve. I was never allowed to meet a medical board. I graduated with my class and completed... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - February 17, 2024 Category: Universities & Medical Training Authors: MT Doc Tags: Military Medicine Source Type: forums

SCS for post laminectomy pain without radiculopathy?
What is your patient selection criteria for SCS in treating primarily axial FBSS? (Source: Student Doctor Network)
Source: Student Doctor Network - January 24, 2024 Category: Universities & Medical Training Authors: cameroncarter Tags: Pain Medicine Source Type: forums

ESP Blocks for Lumbar Laminectomies
Anyone doing this? Have a new neurospine guy coming that is requesting it, seems excessive. (Source: Student Doctor Network)
Source: Student Doctor Network - November 18, 2023 Category: Universities & Medical Training Authors: DocVapor Tags: Anesthesiology Source Type: forums

Lumbar laminectomy/fusion under spinal anesthetic
I have a patient who’s a poor candidate for GETA. Really needs the surgery. I don’t see why this wouldn’t be doable yet you don’t hear about it much. Anyone have experience with such? (Source: Student Doctor Network)
Source: Student Doctor Network - November 4, 2022 Category: Universities & Medical Training Authors: nopain1234 Tags: Anesthesiology Source Type: forums

Case Discussion
Had this case recently, I'll fill in details as we go along. 72 yr old scheduled for a single level laminectomy. Hx of OSA, HTN and known AS. TTE from two years ago shows moderate AS, AVA of 1.2 and preserved EF. METs are limited by chronic back pain. Able to golf but needs a cart to get around since he can't walk. Do you proceed with surgery or repeat TTE? (Source: Student Doctor Network)
Source: Student Doctor Network - August 20, 2022 Category: Universities & Medical Training Authors: Ronin786 Tags: Anesthesiology Source Type: forums

Patient advice
I have a mid-60 year old patient with remote IV drug abuse, HIV and previous lumbar laminectomy still having low back and leg symptoms. Has failed all non-opioid meds, LESIs, MBBs, SI joints. Is currently doing a spinal cord stim trial but not getting a lot of relief and seems to be heading in the direction of a failed SCS trial. At last visit leading up to the trial, patient’s partner put a lot of pressure on me to prescribe an opioid and that it is terrible to have to see patient deal with... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2022 Category: Universities & Medical Training Authors: NeuroGuyIP Tags: Pain Medicine Source Type: forums

Employed by Insurance Companies
Receiving lots of denials from insurance companies. Getting worst each year. Genicular nerve blocks as well as other procedures determined to be experimental in my area as per insurance company based on their 5 minute “UpToDate search” Even performing an epidural steroid injection for a nerve impingement secondary to epidural scarring following a laminectomy. They will approve a repeat surgery though… Are others having difficulty as well? They are cutting reimbursement left and right... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 2, 2022 Category: Universities & Medical Training Authors: BloodySurgeon Tags: Pain Medicine Source Type: forums

SCS trial in patient with alcoholism
I have a patient who drinks daily. She wants a spinal cord stimulator to help with her post laminectomy pain syndrome. I am hesitant as I am worried about possible bleeding issues with her alcohol use. Would you guys do the case? Would you get any labs prior to make sure she isn't at increased risk for bleeding? (Source: Student Doctor Network)
Source: Student Doctor Network - April 28, 2022 Category: Universities & Medical Training Authors: GottaHaveIt Tags: Pain Medicine Source Type: forums

Case of Yellow-tinged CSF?
Hey guys, 66M prior uncomplicated L3-4 spinal fusion with 4 level laminectomy 8 months ago now came in for THA. I offered spinal vs GA with emphasis that he has a higher chance of spinal failure and conversion to GA anyway, he agrees to try spinal. We get into the spinal, I went midline, sitting patient, likely L2-3 ish and got CSF on 1st needle pass with a 25G whitacre, no redirections or anything. He had a brief blood tinge but after that cleared he had persisting yellow CSF. Like... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - July 6, 2021 Category: Universities & Medical Training Authors: ethilo Tags: Anesthesiology Source Type: forums

Help with SCS lead location
Need some ideas. I have a patient that has a history of rectal pain/tailbone pain. 77 year old male, history of L4-L5 laminectomy 15 years ago - essentially not complaining of much back pain. Had some urological procedure (i think prostate biopsy) successfully, but then started having some discomfort in tailbone area a couple of months later. Was sent to physical therapy and they put some type of probe in his rectum (YES YOU READ THAT RIGHT) and manipulated it for some god awful reason... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 25, 2020 Category: Universities & Medical Training Authors: predentalgirl Tags: Pain Medicine Source Type: forums

Your favorite stimulator?
Standard laminectomy and fusion with ongoing radicular pain, leg more than back. What's your go-to, and is it MRI compatible? Is Abbott the only one with a non-rechargeable battery that is MRI compatible? All the IPGs look nice and small now. I figure enough time has passed since the last thread for people to have more thoughts. (Source: Student Doctor Network)
Source: Student Doctor Network - April 30, 2020 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums

SCS with long lumbar instrumentation
Not a lot of experience with patients with long lumbar or thoracolumbar instrumentation for SCS. I have a patient coming in that will likely need an SCS trial, Laminectomy L1 to the sacrum with PLIF L2 to sacrum and instrumentation L1 to S1. On x-ray there is kyphoscoliosis above the upper instrumented vertebral body. Obviously needs advanced imaging as only an x-ray precedes her visit. The junctional disc level looks like a disaster on x-ray. So, looking like the lowest reasonable... SCS with long lumbar instrumentation (Source: Student Doctor Network)
Source: Student Doctor Network - January 9, 2020 Category: Universities & Medical Training Authors: NJPAIN Tags: Pain Medicine Source Type: forums

when after fusion/laminectomy do yo consider SCS therapy?
Honestly, I typically wait atleast a 8months or 1 year before doing a SCS trial and usually after 1-2 ESIs didnt help. But I'm wondering if I'm too conservative.... Surgeons do their surgeries and usually tell patients, "it may take 6months to 1 year" to fuse. They tell their patients that we arent necessarily doing the surgery for pain, but to "stabilize" the spine. I was recently told that in theory if after 3months and there's no fusion or pseudoarthrosis, then one should consider... when after fusion/laminectomy do yo consider SCS therapy? (Source: Student Doctor Network)
Source: Student Doctor Network - October 14, 2019 Category: Universities & Medical Training Authors: PinchandBurn Tags: Pain Medicine Source Type: forums

Challenging case, seeking help from the SDN gurus
I have a patient who had a prior SCS paddle lead placed with laminectomy at T11-12. She had the SCS removed in 2014 and had a L2-L5 fusion in 2016. Surgeon states no further surgery indicated. She presented to me interested in having a new SCS trial. My question is: is a new percutaneous trial possible given the prior laminectomy? And if so, can you enter between the fusion and laminectomy? Above the laminectomy? (Source: Student Doctor Network)
Source: Student Doctor Network - July 28, 2017 Category: Universities & Medical Training Authors: y2janitor Source Type: forums

MILD CMS coverage determination expected today
Interesting to read some of the comments: https://www.cms.gov/medicare-coverage-database/details/nca-view-public-comments.aspx?NCAId=284 Commenter: Desai, SK Title:Neurosurgeon Organization:University of Texas Date: 04/23/2016 Percutaneous image-guided lumbar decompression for lumbar spinal stenosis does not work. This is an example of pain practices trying to expand their scope of practice and bill for a laminectomy code to counter declining reimbursements. (Source: Student Doctor Network)
Source: Student Doctor Network - December 7, 2016 Category: Universities & Medical Training Authors: NOSfan Source Type: forums