Case Scenario

A 48-year-old former construction worker presents for a comprehensive evaluation. The examination does not reveal a history of cancer, trauma, or fever, and the neurologic examination findings are normal. Five years earlier, the patient began having low back pain when lifting heavy materials, and his physician prescribed nonsteroidal anti-inflammatory drugs, a muscle relaxant, and physical therapy. However, the patient was unable to return to work. When his symptoms did not improve, he underwent spinal radiography and magnetic resonance imaging, which showed a small herniated lumbar disk. The patient was referred to a pain management specialist and had three epidural injections that did not improve his symptoms. He was then referred to a spine surgeon and underwent a lumbar laminectomy that did not result in significant improvement. The patient is still unemployed and would like to discuss further therapy with you. His surgeon recommends spinal fusion, but the patient has concerns after reading about the procedure and its risks.