Neurogenic claudication

The patient returns to the office today with MRI for review and discussion of treatment. He is a 76-year-old gentleman who presents with complaints of neurogenic claudication and inability to walk more than half a block due to pain. On reviewing of the lumbar MRI, he does have severe spinal stenosis at the level of L4-L5. This is multifactorial spinal stenosis, which is composed of facet arthropathy and ligamentum flavum hypertrophy. He also has ligamentum flavum hypertrophy at several levels. I discussed with him the treatment options that range from the use of epidural steroid injection, which he has failed treatment to lumbar decompressive laminectomy. We also spoke about the performance of a minimal invasive lumbar decompression, risk, benefit, alternatives and technical aspect of the procedure. I will send him literature to the internet for him and his family to review and discuss it among themselves. Once he feels comfortable and he decides to proceed, he will have a medical clearance and we will sit down with need to discuss the procedure further.

DIAGNOSES:
1. Neurogenic claudication.
2. Chronic low back pain.
3. Spinal stenosis, multifactorial.
4. Obesity.
5. Ligamentum flavum hypertrophy, multilevel.
6. Lumbar facet joint arthropathy, multilevel.

RECOMMENDATIONS:
I discussed with the patient in detail the performance, risk, benefit, alternatives and technical aspect of a minimal invasive lumbar decompression. Literature will be provided to him and his family to read. Once he discussed the procedure with the family and reviewed the literature, he will notify me whether he wants to proceed with this surgical procedure. He will need to have medical clearance prior to the procedure and he will need to stop the aspirin. We discussed this in detail and he will call this office to schedule an appointment when he feels that he is ready.

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