Severe COPD, multilevel lumbar decompression

Gabrielle Morris

75 F for L3/4/5 laminectomy for canal stenosis – radiculopathy main symptom. Opioid naïve.

Background

  • Severe COPD
    • LFTI q 2nd yearly, requiring steroids and antibiotics
    • FEV1 0.58 (34%), FVC 1.29 (55%)
    • NYHA III-IV
    • Not on home O2. SpO2 93% RA in clinic, wheeze in chest.
  • Severe reflux – previously aspiration during gastroscopy 

Issues

  • High risk POPC
  • ? alternatives to surgery
  • Frailty – CFS 5-6

Discussion

  • Reasonable to trial of conservative management with steroid injections 
  • Patient accepts risk of death with surgery due to extremely poor QoL at present, if conservative management fails.
  • Canal stenosis crosses a spectrum of severity, clinical implications and underlying pathology, meaning some may improve over time and be more amenable to non-surgical options. Others may not.
  • Does not meet our criteria for urgent referral to respiratory physician due to likely non-optimisable disease (based on frequency of exacerbations).

Plan

  • Trial of conservative management then likely surgical approach given patient accepting of risks. 
  • ICU level 2, should surgery proceed
  • Referral to HIPS for potential intervention
  • Formal PFTs
  • GP review of COPD given wheeze present in clinic.