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Pain and Spine Medicine

Acute Lower Extremity Weakness Following Lumbar Laminectomy Revision in an Adult with Multiple Sclerosis and Failed Back Surgery Syndrome: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Stefan Hamaway, MD

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Old Westbury, New York

    • Co-Author(s)

  • Eileen Lu, DO

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • GK

    Getahun Kifle, MD

    Asst. Prof
    SUNY Downstate
    Brooklyn, New York

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Health Sciences University
    Brooklyn, New York

Disclosure(s):
Stefan Hamaway, MD: No financial relationships to disclose
Eileen Lu, DO: No financial relationships to disclose
Sanjeev Agarwal, MD: No financial relationships to disclose
Case Diagnosis: Patient with failed back surgery syndrome has complicated rehabilitation course due to MS flare.

Case Description or Program Description: A 51 year old female with history of MS, and lumbar radiculopathy had undergone several back surgeries, most recently a L3-L4 laminectomy in 2023. The patient presents 1 year postop for acute on chronic back pain associated with bilateral lower extremity weakness for 2 weeks and feeling that “something was moving around” in her back, found to have loosening of the hardware on imaging and was taken for L2-L5 revision. Patient was then started on course of PT. On physical exam, strength gradually improved to 4/5 from 3/5 in hip flexors on presentation. On post op day 5 patient had increasing lower extremity weakness down to 3/5 and decreased exercise tolerance with PT. Reflex 2+ throughout with persistent diminished sensation over the bilateral lower extremities.

Setting: Tertiary care hospital center

Assessment/Results: Most recent MRI showed no new enhancing lesions during which she developed similar weakness and was treated empirically for presumed MS flare. Steroids were initiated which improved her strength to 5/5 over 3 days on follow up physical examinations. Neurology was consulted; however, decision was made to discontinue steroids given risk/benefit during the post operative period. The patient strength and mobility continued to improve during her rehabilitation course and was scheduled for neurology and physiatrist follow ups on discharge.

Discussion (relevance): The differential for sudden weakening during the post operative period after laminectomy is broad and include exacerbation of chronic neurologic disorders that require adequate treatment to progress in therapy.

Conclusions: Patients with failed back surgery pain syndrome can present with exacerbations of comorbidites so It is imperative for a physiatrist to take a detailed history and physical exam to elucidate the cause and to maintain a holistic approach including patient education, pain control, psychotherapy, and adaptations to minimize disability.