Medical TRV Session
"Mr. W.D./cause of current pain problem"
January 12, 1997
Monitor: Dr. John Turner
Mr. W.D. is a 58 year old male who was first seen on April 10, 1996 for
complaints of left leg pain, left foot numbness and weakness. He failed
to respond to conservative treatment. CT on 4/11/96 scan revealed a soft
tissue mass in the left lateral recess at the L4 level of the lumbar spine.
MRI on 4/12/96 clearly showed an extruded disc fragment at the L4-5 disc
level with cephalad migration to the left. The L5-S1 disc had a mild bulge.
4/18/96: Left L4-5 hemilaminotomy with microdiskectomy and excision of
A disc bulge was palpated at L4-5 of mild to moderate degree. Since
the MRI had clearly shown a superiorly migrated fragment, laminotomy was
performed superiorly and several disc fragments were teased from the
ventral surface of the dura. There were no fragments extending along the L5
root. The disc space was entered and only small pieces of disc material
could be removed.
Mr. W.D. improved and returned to his home state with mild persistent
weakness of dorsiflexion of his left foot and residual numbness. He was
reinjured when falling from a Captain's boat chair followed by a twisting
injury when working in the engine compartment of his boat. Repeat MRI
scanning with and without contrast agent showed scarring and extruded
fragment at L4-5 and an increase in the bulge at L5-S1. His left leg pain
12/9/96: Left L4-5 hemilaminotomy, medial facetectomy, L5 neurolysis with
removal of disk fragments. Left L5-S1 hemilaminotomy and microdiskectomy.
Considerable scar tissue was found as expected at the L5-S1 level
with small fragments of disk embedded and extruded within the scar tissue.
This required performing a medial facetectomy and foraminotomy to free the
L5 root. At the L5-S1 level, which appeared to be transitional, a hard
bulging disk was found. There were no other pertinent operative findings.
Post-operative course and inclusion of Remote Viewing:
Following surgery, his leg pain was completely relieved. He complained of
back pain during the first post-operative week. This slowly led to
fluctuating leg pain, left greater than right. Some days, he would be pain
free. He remained afebrile and the incision remained intact and normal in
He was sent for physical therapy with heat, massage and ultrasound with
minimal relief. Caudal epidural steroid blocks did not change his pain. On
1/11/97 he complained of bilateral anterior leg pain and bilateral calf
pain. There was no evidence of deep vein thrombosis. Straight leg raising
1/12/97 Remote viewing session:
Monitor: Dr. John Turner
The viewer perceived the origin of pain within the brain and the source of
pain in the lumbar (low back) region. Stage six sketch showed
a 'tubular structure' with a helical flow pattern and an obstruction to the
flow by a 'reddish-brown' material. This material appeared to be of fluid
1/13/97: Examination and MRI:
Patient was afebrile, back and incision appeared normal. Patient describes
an area in the left paralumbar area that when pressed upon, would cause a
radiation of pain to his left leg.
1/14/97: Repeat MRI:
An isolated pocket of suppuration or, perhaps, cerebrospinal fluid can be
seen 2 cm below the skin surface and extending to the level of the L5 nerve
root. Needle aspiration yielded 4 cc of reddish brown material. The patient
was taken to the operating room where a loculated area of reddish-brown pus
was found as expected. Cultures showed growth of coagulase-negative
Staphylococcus and the patient was started on appropriate antibiotics and
twice daily wound packing and irrigation. He has made a good recovery with
the wound healing by second intention.
This represents a case of post-operative infection which was a diagnostic delema
due to atypical symptoms and a fluctuating course of shifting pain
in the back and both lower extremities. The surgical incision gave no clues
about the loculated deep infection. A remote viewing session focusing on
anatomic features revealed obstruction of flow due to an abscess cavity
which communicated with the epidural space and may have impeded normal flow
of cerebrospinal fluid. The RV findings did not suggest a recurrent
herniated disk, but rather, a reddish-brown fluid as the etiologic agent.
This was confirmed by MRI scanning, needle aspiration and surgery.
Remote Viewing shortened the delay in diagnosis and decreased medical costs
of continued physical therapy in this patient with an unusual presentation
of post-operative infection.
John L. Turner, M.D., F.A.C.S.
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