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Abstract
Background and Aims Post laminectomy infective spondylodiscitis has poor prognosis. Management includes antibiotics, bedrest and repeat surgery with attendant morbidity. We highlight the importance of muscle contribution to the pain, stiffness and restricted mobility in post laminectomy syndrome.
Methods Case report: 45 y/lady/90 kg presented 9 months after micro discectomy of L4–5 with severe backpain (NRS- 8–9/10) stiffness, restricting spine movements, and severe shocks in right lower extremity. MRI showed infective spondylodiscitis at L4–5, scarring around traversing right L5 and S1 nerves. Antibiotics had been ineffective.
Management Patient received weekly Ultrasound guided dry needling (USGDN) for the muscles of the back, thigh, calf , foot and sole, performed alternately in supine and prone position for 3 months. Musculoskeletal Ultrasonography of the back at, above and below the scar was performed at the beginning of the treatment, 6weeks and 12 weeks.
Results Patient reported decrease in the pain, stiffness and improved flexibility with each USGDN session. At 12 weeks she was able to perform her daily activities of life like walking, cooking for one hour, caring for her child and maintaining the house with change in personality and restoration of self- confidence. The first ultrasonography showed severe effusion around the erector spinae muscles, fibrosis and loss of normal muscle architecture in the surgical scar. 6 and 12 week studies showed islands of muscle recruitment, restoration of fascicular pattern in the areas of fibrosis and increase in muscle thickness.
Conclusions Treatment of myofascial pains significantly improved the post-laminectomy pains and disability in this patient.