laminectomy with radicular symptoms

[Hayden123]

I need some advice on a patient. I am currently seeing a patient that injured her back when lifting a credit card machine at work. It was initial severe pain in back and into L LE. She work for half day before going to ER and having xray and MRI which showed a mass at L2 level on her nerve. It was the L1-2 disc sequestration fragment. The injury happened in Nov 2007. She had outpatient surgery in January for the removal of the disc fragment and laminectomy. She did not receive any PT or have a brace after surgery. she was given exercise to perform on her own. She returned to MD in March and he ordered PT.

Prior level of function: Independent with all activiity and no prior back problems.

PMH: no significant hx

at initial eval pt had several major deficits:
-gait: flexed trunk 35 degrees side bend to R and rotated. Pt decrease hip flexion on the L and DF.
-Strength: DF, quad, 2-/5, hip flexion 2/5 (this is all L LE). hip abduction 2+/5
-SLR on L =30 degrees with radicular to foot.
-ROM: Pt unable to extend in standing to -30. when I try to self correct her to normal erect posture she has severe pain and radicular symptoms into her L LE.
-Pain: 6/10 with regular activity, 8/10 with walking, standing for more than 5 min. She mainly complains of pain in L groin area (L2 sensory distribution) She also states I have a catch in L low back. She stated she can't stand straight because of pain or catch in PSIS and SI region on L.
Sensation: She has numbness in upper thigh L2 area and a point of numbness that she says has never returned since surgery at mid inner thigh the size of a quarter.

I have tried US/estim in area of SI and PSIS secondary to severe mm guarding and pain. I have also started her on prone exercises to increase extension and increase mm strength back extensors. I have also incorporated stretching activites for SKC, pelvic tilt, Hamstring stretch etc. She has increase radicular symptoms with hamstring stretch and increase groin pain with pulling knee to chest.
She has made minimal gains with therapy so far. She has had slight increase to 30 in standing for flexion but minimal strength gains.

Please give any suggestions. She did return to MD approximately 1 week ago and he said she was right on track per pt. I have phoned MD but no reply. She states she has never been told by neurologist of any nerve damage, but I know she has some. She also sees a General MD that mentioned to her at the end of the week that she may be "stuck like she is". I just don't know where to go from here.

I have given her lumbar roll for sitting. Do you think any brace would benefit? I have mixed feelings about braces. I know they are support and in her case she is so flexed, but also think she may become depended on a brace and not her mm. She is a very difficult case. i have not had much experience with surgical patients with this much deficit noted with just affecting L2 nerve root. Please any help would be greatly appreciated. Also, any suggestions as to what is causing the "catch" in PSIS /SI region on L. I know she is compensating all over for her severe posture but any other suggestions.