A patient has undergone Charite disk implant in 2006, In 2014 it failed. two attempts to alleviate the damage failed and the pain has gotten progressively worse. At present there is no sensation in the legs and mobility is affected.
One of the most causes of failed back surgery is abnormal (gravity drive) foot pronation. Include in your differential diagnosis PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus foot structure. If this patient has either of these abnormal inherited foot structures, treat with the appropriate proprioceptive insoles. This will attenuate or eliminate most of their pain.
The Mechanical Diagnosis and Treatment approach offers graded, mechanical diagnostic overpressure to the spine , as a diagnostic and therapeutic tool to rapidly discern any possibility of controlling leg pain/ paresthesia / numbness and weakness originating in the spine. It involves use of an he evidence based concept of directional preference. In short, it is a specific direction of movement or positioning to the thoracic or lumbar spine may in fact produce a desired change in leg symptoms. Among the responders, up to 70% will not initially require manual procedures to sustain a benefit of self symptom control.
Thank you Tony H all , Brian Alex Rothbart and Beata Smela for your very informative answers. I now realize I did not describe the nature of the failure. It seems to involve a break in the ring of the Charite implant which happened 8 years after the operation. Would this affect your answers?
If the person is mobile (able to walk, get dressed etc.) and the surgery is not indicated at this time, it would not affect my answer.
I agree with Tony Hall above.
You do not mention spinal level and extent of neurological impairment.
Referral to spinal rehab unit may provide a more logical path forward if this is a near complete transection.
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