Opinion ID: 584559
Heading Depth: 4
Heading Rank: 1

Heading: Central DuPage Hospital

Text: 5 Ms. Scivally was examined in the emergency room of Central DuPage Hospital following the November 11, 1986 accident. Ms. Scivally complained of pain in her lumbar spine radiating into her buttocks. She did not experience tingling or numbness, and she had a full range of spinal motion. Ms. Scivally had paralumbar tenderness, and medical personnel diagnosed paraspinal strain. 6 On November 19, 1986, X-rays taken of her spine showed straightening of the normal lumbar lordosis, anterolateral spurs at several levels, a narrowing of the L5-S1 disc space and slight demineralization of the bones. A comparison with 1983 X-rays disclosed a progressive change in her degenerative arthritis. A CT scan performed at the hospital on December 17, 1986, revealed that: 7 There are six lumbar vertebral bodies. There are hypertrophic and degenerative changes of the facet joints. There are small bony spurs in combination with bulging disc at the level of L5-6. There is narrowing of the neural foramen at the level of L4-5 on the left, and L6-S1 bilaterally. There is a vacuum phenomenon at the level of L-4, 5 and L-5, 6. 8 Ms. Scivally also participated in two sessions of physical therapy at Central DuPage Hospital. During the first session, in December, 1986, she reported lower back pain that increased upon sitting or bending, and she occasionally experienced pain in her buttocks. The therapist noted a right lateral shift while standing, a slightly decreased lordosis, minimal limitations to spinal flexion and extension, normal muscle tone, strength and sensation. A discharge report prepared on January 6, 1987, noted that Ms. Scivally's pain had not decreased, although a lumbar roll made sitting more comfortable. Her trunk motion flexion and extension were within normal limits, but she experienced pain at the end of the range and when returning to a standing position. There was a slightly decreased lordosis, but the lateral shift had been corrected. The therapist's goals were partially met, but it was noted that the patient showed little improvement from the physical therapy. 9 Ms. Scivally again received physical therapy between January 26 and February 18, 1987. She continued to complain of lower back pain, with no improvement after the earlier physical therapy session. The therapist noted a slight scoliosis convex to the right lumbosacral region and decreased lumbar lordosis. The claimant experienced limited loss of motion of flexion to the ankles, moderate loss of motion on extension and minimal loss of motion on rotation. After several appointments, which produced no improvement of her lower back pain, the therapist suggested the use of a TNS (transcutaneous electrical nerve stimulation) unit to help decrease the pain. Ms. Scivally did report some improvement after using the TNS. The discharge report stated that the therapist's goals were met. While noting little decrease in the lower back pain, the therapist reported increased activity level, minimal loss in trunk motion, unremarkable gait, decreased lumbar lordosis, which had improved since the first appointment, improved posture, mild scoliosis and normal lower extremity strength. 10