What do you guys think.
International patient seen a few weeks ago (those are THE BEST.....) at my hospital outpatient clinic for eval. 35 or so yo F w history of several years of axial back pain with left>right leg pain. Has had injections (probably facet) done in Germany which didn't relieve pain. Didn't really do any PT. Saw her, had shooting pain of L leg posterior aspect w/ SLR, minimal facet loading pain, pain with deep palpation of lumbar paraspinals. CT myelogram done shows pars defect and mild spondylosis. She was seen by neurosurgeon at a different hospital who told her she had bilateral L5 pars fractures and wanted her to get bilateral L5 pars injection. She then had a bone scan, which was negative for pars defect or other fractures. Came back to see me, and told me her left leg was what bothered her the most. I did a lumbar ESI on her and she had 100% pain relief for several days. She went back to see the neurosurgeon who then angrily called me asking me why I didn't do a pars injection like he asked me to (he didn't refer the patient to me, and I have no idea who he is) and I told him I did what I felt was best for her based on my exam.
I have never done a pars injection in my career (short as it may be) and just wanted some input; to be honest, was a little bit frazzled by this neurosurgeon who called and bitched at me for not doing what he wanted me to do. He actually hung up on me! TIA.
International patient seen a few weeks ago (those are THE BEST.....) at my hospital outpatient clinic for eval. 35 or so yo F w history of several years of axial back pain with left>right leg pain. Has had injections (probably facet) done in Germany which didn't relieve pain. Didn't really do any PT. Saw her, had shooting pain of L leg posterior aspect w/ SLR, minimal facet loading pain, pain with deep palpation of lumbar paraspinals. CT myelogram done shows pars defect and mild spondylosis. She was seen by neurosurgeon at a different hospital who told her she had bilateral L5 pars fractures and wanted her to get bilateral L5 pars injection. She then had a bone scan, which was negative for pars defect or other fractures. Came back to see me, and told me her left leg was what bothered her the most. I did a lumbar ESI on her and she had 100% pain relief for several days. She went back to see the neurosurgeon who then angrily called me asking me why I didn't do a pars injection like he asked me to (he didn't refer the patient to me, and I have no idea who he is) and I told him I did what I felt was best for her based on my exam.
I have never done a pars injection in my career (short as it may be) and just wanted some input; to be honest, was a little bit frazzled by this neurosurgeon who called and bitched at me for not doing what he wanted me to do. He actually hung up on me! TIA.