Physical Therapy Management of a Patient with Residual Neurologic Deficits Following Lumbar Decompression Surgery

Background: The symptoms associated with lumbar spinal stenosis (LSS) can severely impact a person’s quality of life. Along with back pain, symptoms might include lower extremity numbness, tingling, pain, cramping, motor control deficits, and weakness. Both lumbar decompression surgery and physical rehabilitation are considered effective treatments for LSS. Case Description: The patient was a 76-year-old male with a 30-year history of back pain and LSS. He had recently undergone a lumbar decompression surgery which relieved the majority of the pain, but motor deficits remained. He was referred to physical therapy to improve ambulation and decrease fall risk. Intervention Strategies: The patient underwent two months of physical therapy focused on the following intervention strategies: gait training, ankle motor control, general lower extremity strengthening, lower extremity endurance training, static and dynamic balance training. The main focus of treatment was shifted towards functional improvements one month into treatment. Outcome Measures: The outcome measures used throughout this patient’s treatment included the Four Stage Balance Test, Oswestry Disability Index, and manual muscle testing of the lower extremities. Discussion: The purpose of this case study was to describe the specific balance, resistance, and gait training interventions used to treat a patient status post lumbar decompression surgery for chronic LSS. The patient showed clinically meaningful improvement in perceived disability. The patient was able to decrease use of assistive devices considerably, and showed improvements in lower extremity strength, ambulation quality, static balance, dynamic balance, and fall risk.