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When a Pacemaker Forces Us to Think Differently in Failed Backs

When a Pacemaker Forces Us to Think Differently in Failed Backs
This 55-years old man with a pacemaker came in July 2014 with back-pain and intermittent claudication. Since an MRI could not be done, a CT myelogram was done, which shows canal stenosis at L4/5 (red arrow) and mild disease at L3/4 (blue arrow). He had a laminectomy, but in Sept 2015, he started getting pain and claudication again. We repeated a CT myelogram, which shows that L4/5 (red arrow) is now capacious, but the canal stenosis at L3/4 (blue arrow) has progressed significantly.
This is a known phenomenon. Often after a laminectomy, the immediately superior, non-operated level, progresses rapidly, if there was mild disease to begin with. This is one of the causes of a failed back.
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