INFUSE BONE GRAFT
Report
- Report Number
- 1030489-2014-04255
- Event Type
- Injury
- Date Received
- November 6, 2014
- Report Date
- October 9, 2014
- Manufacturer
- MEDTRONIC SOFAMOR DANEK USA, INC
- Product Code
- NEK
- PMA / PMN Number
- P000058
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AL, US
- Reporter Occupation
- ATTORNEY
Narratives
(B)(6). (B)(4). NEITHER THE DEVICE NOR FILMS OF APPLICABLE IMAGING STUDIES WERE RETURNED TO THE MANUFACTURER FOR EVALUATION. THEREFORE, WE ARE UNABLE TO DETERMINE THE DEFINITIVE CAUSE OF THE REPORTED EVENT.
IT WAS REPORTED THAT THE PATIENT PRESENTED TO SURGERY WITH DEGENERATIVE L4-5 AND L5-S1 DISKS WITH NEUROFORAMINAL STENOSIS AND BILATERAL LOWER EXTREMITY RADICULOPATHY. PROCEDURE: 360 DEGREES LUMBAR FUSION L4-5 AND L5-S1 INCLUDING: POSTEROLATERAL FUSION L4-S1; POSTERIOR LUMBAR INTERBODY FUSION WITH CAGES L4-5 AND L5-S1; POSTERIOR PEDICLE SCREW INSTRUMENTATION L4 TO S1; DECOMPRESSION LAMINECTOMY WITH BILATERAL FACETECTOMIES L4-5 AND L5-S1; LOCAL AUTOGRAFT BONE GRAFT WITH BONE MORPHOGENIC PROTEIN AND SYMPHONY PLATELET GEL. AFTER DECOMPRESSION WAS COMPLETED, ATTENTION WAS DIRECTED TO THE DISK SPACES BETWEEN THE AXILLA OF THE L4 AND L5 NERVE ROOTS AND THE L5 AND S1 NERVE ROOTS ON THE RIGHT SIDE. ANNULUS WAS OPENED. THERE WAS MARKED COLLAPSE OF THE DISK SPACES WHICH CONTRIBUTED TO THE NEUROFORAMINAL STENOSIS. DISK REMNANTS WERE REMOVED. AFTER THE DISK SPACE WAS ADEQUATELY DISTRACTED. THE APPROPRIATE SIZED INTERBODY CAGE WAS PACKED WITH PREVIOUSLY HARVESTED AUTOGRAFT AND BONE MORPHOGENIC PROTEIN ON A COLLAGEN SPONGE. BONE MORPHOGENIC PROTEIN WAS ALSO PLACED ANTERIORLY TO THE CAGE IN THE DISK SPACE. ATTENTION WAS THEN DIRECTED TO THE L5-S1 DISK SPACE WHERE DISCECTOMY DISTRACTION AND STABILIZATION WITH INTERBODY CAGE WAS COMPLETED. PEDICLE SCREWS PLACED AT L4, L5, AND S1 PEDICLES BILATERALLY. LORDOTIC RODS WERE PLACED FROM THE PEDICLE SCREW TO PEDICLE SCREW AND CROSS LINKS WERE PLACED AT BOTH DISK SPACES L4-5 AND L5-S1. INCISION WAS IRRIGATED WITH ANTIBIOTIC SOLUTION. ATTENTION WAS DIRECTED TO THE LATERAL GUTTERS WHERE BONE MORPHOGENIC PROTEIN WAS PLACED FROM TRANSVERSE PROCESS TO TRANSVERSE PROCESS FORM L4-L5 TO THE ____. THIS WAS COVERED WITH THE REMAINING AUTOGRAFT BONE AFTER BEING PLACED THROUGH A BONE MILL. PARA SPINAL MUSCLES WERE PULLED UP OVER THE BONE GRAFT AND THE HARDWARE, AND AGAIN THE MIDLINE WAS IRRIGATED WITH ANTIBIOTIC SOLUTION. THE WOUND WAS SPRAYED WITH SYMPHONY PLATELET GET TO PROMOTE HOMEOSTASIS AND THE FASCIA CLOSED. THE PATIENT TOLERATED THE PROCEDURE WELL. (B)(6) 2005- DISCHARGE SUMMARY- PRINCIPLE DIAGNOSIS AND PROCEDURE SAME AS DOCUMENTED ABOVE. NARRATIVE SUMMARY- HISTORY OF DEGENERATIVE DISK DISEASE IN BOTH THE CERVICAL AND LUMBAR SPINE. LEG PAIN HAD BECOME MORE SYMPTOMATIC TO THE POINT SHE WAS LIMPING AND USING A CANE FOR AMBULATING. CONSERVATIVE TREATMENT FAILED AND SHE REQUESTED MORE AGGRESSIVE TREATMENT. PLIF WAS COMPLETED (B)(6) 2005 WITHOUT DIFFICULTY. SHE REMAINED AFEBRILE AND VITAL SIGNS WERE STABLE THROUGHOUT THE HOSPITAL STAY. PATIENT WAS TOLERATING PAIN FIRST ON MORPHINE PCA AND THEN SWITCHED TO ORAL LORCET. DRESSING CHANGED ON POSTOPERATIVE DAY 2, INCISION DRY AND HEALING WELL THEREAFTER. PATIENT REQUESTED DISCHARGE ON EVENING OF 3RD POSTOPERATIVE DAY AND WAS DISCHARGED ON THE MORNING OF HER 4TH POSTOPERATIVE DAY IN MUCH IMPROVED CONDITION OVER THAT OF HER ADMISSION. DISCHARGE MEDICATIONS: LORCET 10MG 1-2 Q 4-6 HOURS PRN FOR PAIN. VALIUM 5MG 1 TID PRN SPASMS. BABY ASPIRIN 81MG DAILY. NEURONTIN 300 MG 1 BID. MULTIVITAMIN AND CALCIUM DAILY. WALKER WITH WHEELS PROVIDED TO THE PATIENT TO BE UTILIZED AS NEEDED. (B)(6) 2010- OFFICE- PATIENT SEEN BECAUSE OF NECK, SHOULDER AND ARM PAIN. STATUS POST ANTERIOR CERVICAL FUSION TIME TWO LAST ONE IN 2003. LEFT SIDE HURTS WORSE THAN RIGHT. PAIN TO HER HAND WITH NUMBNESS. ALSO COMPLAINS OF LOW BACK AND LEG PAIN. LAMINECTOMIES TIMES TWO, LAST IN 2005. NO RECENT PHYSICAL THERAPY OR NONSTEROIDAL ANTI-INFLAMMATORIES. SHE HAS HAD LESI¿S AND CESI¿S IN THE PAST. MRI LUMBAR SPINE DEGENERATIVE DISCS AT L4-5, L5-S1 WITH DECOMPRESSION LAMINECTOMY AND FACETECTOMIES AT L4-5 AND L5-S1. POSTERIOR PEDICLE SCREW INSTRUMENTATION L4 TO S1 AND POSTERIOR LUMBAR INTERBODY FUSION WITH CAGES AT L4-5 AND L5-S1. CURRENT MEDICATION- OXYCODONE, TRAMADOL, _____ , VITAMIN C AND ASPIRIN. EXAM: DECREASED RANGE OF MOTION OF NECK AND CAN OPEN MOUTH WIDE. NEUROLOGIC- DECREASED SENSATION IN LEFT C5-6 AND C6-7 DISTRIBUTION, OTHERWISE NORMAL SENSATION BILATERALLY IN UPPER EXTREMITIES TO LIGHT TOUCH. INCREASED DEEP TENDON REFLEXES BILATERALLY UPPER EXTREMITIES. EPIDURAL STEROID INJECTIONS EXPLAINED IN DETAIL. (B)(6) 2010- MRI LUMBAR SPINE WITHOUT CONTRAST- IMPRESSION- POST SURGICAL CHANGES INCLUDING LAMINECTOMY AND FUSIONS FROM L4-S1. DEGENERATIVE DISC DISEASE, NO EVIDENCE OF CORD OR NERVE ROOT COMPRESSION. (B)(6) 2010- MR C SPINE- IMPRESSION- POST SURGICAL CHANGES AS DESCRIBED- CERVICAL VERTEBRAL BODIES ARE NORMAL IN ALIGNMENT AND HEIGHT. FIXATION HARDWARE LIKELY REPRESENTING A FIXATION PLATE ANTERIOR TO THE C6 AND C7 VERTEBRAL BODIES WITH SCREWS IN EACH VERTEBRAL BODY, APPEAR TO BE SPACING DEVICES WITHIN C4-5, C5-6 AND C6-7 SPACES. DEGENERATIVE DISC DISEASE. MILD CENTRAL SPINAL STENOSIS AT MULTIPLE LEVELS WITH NO EVIDENCE OF CORD OR NERVE ROOT COMPRESSION. (B)(6) 2010- RETURN VISIT. PATIENT SEEN IN CONSULTATION ON (B)(6) 2010. THE PATIENT RETURNS TODAY FOR PAPERWORK. APPLYING FOR FAMILY HOME LEAVE. WE WERE ABLE TO DESCRIBE THAT SHE HAS CERVICAL AND LUMBAR PATHOLOGY AND THIS MAY LAST A LIFETIME OR IT MAY BE INTERMITTENT OR EPISODIC IN NATURE. (B)(6) 2010- RETURN VISIT. PATIENT WAS SEEN IN CONSULTATION ON (B)(6) 2010. THE PATIENT RETURNS TODAY FOR PAPERWORK WE SPENT 15-20 MINUTES DOING PAPERWORK. (B)(6) 2010- RETURN VISIT. SEEN IN CONSULTATION ON (B)(6) 2010. PATIENT RETURNS TODAY FOR PAIN MEDICATION. (B)(6) 2011- RETURN VISIT FOR PAIN MEDICATION AND PAPERWORK. VALIUM- 10MG 1 BID. PAPERWORK COMPLETED. (B)(6) 2011- EPIDURAL STEROID INJECTION AT L2-L3 INTERSPACE. DIAGNOSIS- LUMBAR INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY. 80MG DEPO-MEDROL DILUTED TO 5CC WITH 0.5% LIDOCAINE. (B)(6) 2011- ER- COMPLAINS OF GENERALIZED PAIN AFTER TRIPPING UP THE STAIRS OVER THE DOG. TRAUMA TO LEFT HIP, RIGHT KNEE, RIGHT SHOULDER. INITIAL IMPACT RIGHT KNEE. X-RAY-LEFT SHOULDER AND PELVIS-NEGATIVE. CT C SPINE-NEGATIVE. FINAL IMPRESSION- CERVICAL STRAIN. STABLE, PAIN MEDS GIVEN. (B)(6) 2011 CT CERVICAL SPINE WITHOUT CONTRAST- HISTORY- NECK PAIN/TRAUMA. IMPRESSION- NO ACUTE INJURY IN THE CERVICAL SPINE, LEFT SHOULDER OR PELVIS. POSTSURGICAL CHANGES IN THE CERVICAL AND LUMBAR SPINE. DEGENERATIVE DISK AND FACET DISEASE DISK GREATER THAN FACET IN THE CERVICAL SPINE. (B)(6) 2011- RETURN VISIT FOR PAIN MEDICATION. VALIUM 10 MG BID. FILLED OUT FMLA PAPERWORK. (B)(6) 2011- EPIDURAL STEROID INJECTION C6-C7 INTERSPACE. DIAGNOSIS- CERVICAL INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY. 80MG DEPO-MEDROL DILUTED TO 5CC WITH 0.5% LIDOCAINE. (B)(6) 2011- RETURN VISIT TO DISCUSS NECK PAIN. WE DID ONE CERVICAL EPIDURAL STEROID INJECTION AFTER WHICH HER PAIN RESOLVED BY ABOUT 20% BUT SHE STILL HAS PAIN. THE PROBLEM IS WHENEVER SHE HAS STEROID INJECTIONS IT INCREASES HER MANIA WHICH IS MANAGED BY DR. (B)(6). RECOMMEND CERVICAL PHYSICAL THERAPY AND MASSAGE TO AVOID THE MANIA. DIAGNOSIS- CERVICALGIA. (B)(6) 2011- PHYSICAL THERAPY- DIAGNOSIS- CERVICALGIA AND LUMBAR SPINE PAIN (B)(6) 2011- RETURN VISIT- FOR PAPERWORK WHICH SHOWS THAT SHE CONTINUES TO HAVE CERVICAL PAIN, CERVICALGIA, SHOULDER PAIN AND ARM PAIN AND THAT SHE MAY NEED INTERVENTIONS FOR THE REST OF HER LIFE TO HELP WITH PAIN. (B)(6) 2011: PHYSICAL THERAPY PROGRESS NOTE- DIAGNOSIS- NECK AND LUMBAR SPINE PAIN. GOOD PROGRESS. CONTINUE THERAPY. (B)(6) 2011- RETURN VISIT FOR PAPERWORK FOR HMLA, FILLED OUT AND SIGNED. (B)(6) 2012- RETURN VISIT FOR REVIEW OF NECK PAIN. CONTINUES TO HAVE NECK, SHOULDER AND ARM PAIN AND WEAKNESS AND NUMBNESS. HAS BEEN DOING PT. CT SCAN DONE (B)(6) 20/11. MULTIPLE FALLS SINCE SECONDARY TO HER DOGS. MRI CERVICAL SPINE AND BRAIN SINCE SHE HAS HAD SOME HEAD INJURIES WITH THE FALLS. (B)(6) 2012- CERVICAL MRI- IMPRESSION- MULTILEVEL ANTERIOR DISCECTOMY AND FUSION C4-C7. MILD FORAMINAL NARROWING AT C5-6. DOUBT SIGNIFICANT NERVE ROOT ENTRAPMENT. SLIGHT RETROLISTHESIS OF C3 WITH RESPECT TO C4 PRODUCES MILD STENOSIS WITHOUT CORD OR NERVE ROOT ENTRAPMENT.(B)(6) 2012- MRI BRAIN- CHRONIC HEADACHES AND VERTIGO. IMPRESSION- NEGATIVE MRI OF THE BRAIN. (B)(6) 2012- PHYSICAL THERAPY- DIAGNOSIS- CERVICAL SPINE PAIN. (B)(6) 2012- RETURN VISIT FOR PAPERWORK. UPDATED HISTORY FOR WORK. MRI¿S REVIEWED BRAIN-NORMAL, CERVICAL- SLIGHT PROGRESSION OF HER (B)(6) 2012- EPIDURAL STEROID INJECTION C6-C7 INTERSPACE. DIAGNOSIS- CERVICAL INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY. 80MG DEPO-MEDROL DILUTED TO 5CC WITH 0.5% LIDOCAINE. (B)(6) 2012- RETURN VISIT- FOR PAPERWORK CONTINUES TO COMPLAIN OF NECK PAIN. COMPLETED DISABILITY PAPERWORK.(B)(6) 2013- EPIDURAL STEROID INJECTION C6-C7 INTERSPACE. DIAGNOSIS- CERVICAL INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY. 80MG DEPO-MEDROL DILUTED TO 5CC WITH 0.5% LIDOCAINE.(B)(6) 2013- HISTORY AND PHYSICAL EXAM- SAME AS (B)(6) 2010. ASSESSMENT- INTERVERTEBRAL CERVICAL AND LUMBAR DISC DISORDER WITH MYELOPATHY, POST LAMINECTOMY SYNDROME OF LUMBAR REGION AND LONG TERM USE OF DRUG. RETURNS FOR PAPERWORK LAST INJECTION HELPED 30%. MEDICATION HISTORY- SEROQUEL XR 200MG 1 . BACLOFEN 20 MG 1 TABLET, DIAZEPAM 10MG 1 TABLET, OXYCODONE 15MG 1 TABLET. (B)(6) AND MEDICATIONS SAME AS (B)(6) 2013. RETURNS FOR PAPERWORK. (B)(6) 2013 MRI C-SPINE- IMPRESSION- OPERATIVE CHANGES OF THE ANTERIOR INTERBODY FUSION FROM C4 THROUGH C6, WITHOUT EVIDENCE OF RECURRENT CENTRAL CANAL STENOSIS OR DISC PROTRUSION AT THE OPERATIVE LEVELS. MODERATE (STABLE) LEFT C6-C7 NEUROFORAMINAL NARROWING SECONDARY TO UNCINATE HYPERTROPHY. PROGRESSIVE LEFT C3-C4 PARACENTRAL DISC BULGE RESULTING IN MODERATE LEFT LATERAL RECESS STENOSIS AND MODERATE LEFT FORAMINAL NARROWING. MILD CENTRAL CANAL STENOSIS IS ALSO PRESENT AT THIS LEVEL AND NEW FROM PREVIOUS EXAM. (B)(6) 2013- HISTORY, PHYSICAL EXAM AND MEDICATIONS- SAME AS (B)(6) 2013. RETURNS FOR PAPERWORK AND PAIN MEDICATION. MRI REVIEWED- SAME EXCEPT FOR PROGRESSION OF A C3-C4 DISC BULGE WITH MODERATE LEFT LATERAL RECESS STENOSIS AND NEURAL FORAMINAL NARROWING. PAIN MEDICINE HAS PREVIOUSLY BEEN MANAGED BY HER PSYCHIATRIST AND WOULD LIKE TO SWITCH TO US FOR PAIN MEDICATION. LAST TIME THEY ROLLED HER PAIN MEDICATIONS WAS 2 WEEKS AGO. WILL START DILAUDID 2MG 1 TABLET QID. SEE HER BACK FOR OXYCODONE, DIAZEPAM AND BACLOFEN. CONTINUE TO SEE PSYCHIATRIST FOR SEROQUEL. SIGN CONTRACT TODAY. COMPLETE NOTE FOR WORK CLARIFYING BREAKS. U/A PRE-SCREEN RESULTS: POSITIVE RESULTS: BZO, PCP AND TCA. NEGATIVE RESULTS: COC, OPI, AMP, BAR, MTD, THC, MDMA AND BUP. PREGNANCY-NEGATIVE. (B)(6) 2013- HISTORY, PHYSICAL, ASSESSMENT- SAME AS (B)(6) 2013. NEW MEDICATION STARTED (B)(6) 2013: DILAUDID 2MG- 1 TABLET QID. RETURNS FOR CORRECTION FOR NOTE FOR WORK. REVIEW OF CERVICAL MRI FROM (B)(6) 2013 AGAIN- DISC DEGENERATION C2-C3. DISC BULGING C3-C4. NEURAL FORAMINAL NARROWING OR STENOSIS C3-4, C5-6 AND C6-7. CENTRAL CANAL STENOSIS C3-4, C5-6. ALREADY KNOWN OPERATIVE CHANGES FROM ALIF C4-C5 AND C6-C7 . NO EVIDENCE OF RECURRENT CENTRAL CANAL STENOSIS OR DISC PROTRUSION AT OPERATIVE LEVELS. C3-4 DISC BULGE IS PROGRESSIVE AND WORSE THAN PREVIOUS MRI¿S. REFER TO DR. (B)(6) FOR EVALUATION AND TREATMENT OF CERVICAL SPINE. (B)(6) 2013- EPIDURAL STEROID INJECTION C6-C7 INTERSPACE. DIAGNOSIS- CERVICAL INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY. 80MG DEPO-MEDROL DILUTED TO 5CC WITH 0.5% LIDOCAINE. (B)(6) 2013- HISTORY, PHYSICAL, AND ASSESSMENT SAME AS (B)(6) 2013. MEDICATIONS- SAME AS (B)(6) 2013 PLUS DILAUDID 2MG 1 QID. RETURNS FOR PAIN MEDICATION AND LETTER. NEEDS A COPY OF MRI. NEEDS SOMA. CHIROPRACTIC ADJUSTMENTS FOR THORACIC SPINE PRESCRIBED. SOMA 350MG 1 TABLET TID STARTED. (B)(6) 2013- CT CERVICAL SPINE- INDICATION- TRAUMA AND PAIN. IMPRESSION- POSTOPERATIVE CHANGES. NO ACUTE FINDINGS/FRACTURES. (B)(6) 2013- INDICATION- TRAUMA AND PAIN. TWO VIEW LEFT TIBIA AND FIBULA AND FEMUR. NO ACUTE FINDINGS/FRACTURES. MILD DEGENERATIVE CHANGES LEFT HIP. SINGLE VIEW PELVIS- POSTOPERATIVE CHANGES LOWER LUMBAR SPINE, MILD DEGENERATIVE CHANGES BOTH HIPS. NO ACUTE FINDINGS/FRACTURES. THREE VIEW LEFT ELBOW NO ACUTE FINDINGS/ FRACTURES. (B)(6) 2013, CT BRAIN WITHOUT CONTRAST- INDICATION- FALL- TRAUMA TO FRONTAL HEAD POSSIBLE LOSS OF CONSCIOUSNESS. NO INTRACRANIAL HEMORRHAGE OR MASS. (B)(6) 2013- MRI THORACIC SPINE WITHOUT CONTRAST- INDICATION- BACK PAIN, TINGLING IN LEGS, NUMBNESS, LEFT LEG NUMBNESS. IMPRESSION-OTHER THAN SMALL VERTEBRAL BODY HEMANGIOMA OF T6, THORACIC MRI IS UNREMARKABLE. (B)(6) 2013- MRI LUMBAR SPINE WITHOUT CONTRAST- INDICATION- POST FALL, BILATERAL LEG NUMBNESS/TINGLING. IMPRESSION- POSTOPERATIVE CHANGES FROM L4-S1 LAMINECTOMY AND FUSION. MILD DEGENERATIVE CHANGES. OTHERWISE UNREMARKABLE. (B)(6) 2013- HISTORY, PHYSICAL AND ASSESSMENT SAME AS (B)(6) 2013. RETURNS FOR PAIN MEDICATION. MEDICATION LIST- DILAUDID 2MG 1-TID. SEROQUEL XR 200 1, SOMA 350MG 1 TID. BACLOFEN 20MG 1 TABLET. DIAZEPAM 10MG 1 TABLET, OXYCODONE 15MG 1 TABLET. NEW PRESCRIPTIONS- MORPHINE ER 15MG 1 TABLET TID AND CELEBREX 200MG BID. (B)(6) 2013- HISTORY, PHYSICAL AND ASSESSMENT SAME AS (B)(6) 2013 WITH NEW ASSESSMENT ADDED FOR POSTLAMINECTOMY SYNDROME OF CERVICAL REGION. RETURNS FOR PAPERWORK. MEDICATIONS AS LISTED (B)(6) 2013. HISTORY, PHYSICAL, ASSESSMENT AND MEDICATIONS SAME AS (B)(6) 2013. RETURNS FOR PAPERWORK FOR WORK AND DISABILITY EVALUATION. (B)(6) 2013- ADMISSION FOR OPIATE AND ALCOHOL ABUSE- HISTORY- BIPOLAR DISORDER. BROUGHT TO ER BY FAMILY BECAUSE OF BEING TOO MANIC, ABUSING PAIN MEDICATION AND DRINKING. FAMILY FEELS PATIENT IS OVERMEDICATED. POSITIVE FOR CHRONIC PAIN DUE TO DEGENERATIVE DISC DISEASE-6 SURGERIES. CURRENT MEDICATIONS ACCORDING TO THE ER: OXYCODONE 15MG 4 TIMES DAILY. TRAMADOL 50MG 3 TIMES DAILY. VALIUM 10MG 2 TABLETS AT BEDTIME. MORPHINE 15MG 3 TIMES DAILY. SEROQUEL 200 MG BEDTIME. CELEBREX 200MG BID. BACLOFEN. LOPERAMIDE. DIAGNOSIS- AXIS1: OPIATE, AND ALCOHOL ABUSE. BIPOLAR MOOD DISORDER-MANIC. AXIS LL: DEFERRED. AXIS LLL: MEDICAL ISSUES AS ABOVE. AXIS LV: SEVERE. AXIS V 25-30. PATIENT IS EXTREMELY MANIC AND UNABLE TO BE REDIRECTED NEEDED TO BE PUT ON ONE TO ONE FOR SAFETY. NOT APPROPRIATE FOR CHEMICAL DEPENDENCY UNIT. (B)(6) 2013 ¿ INPATIENT PROGRESS NOTE- LESS MANIC. SLEEPING AND EATING. PLAN TO DISCHARGE- OUTPATIENT INTENSIVE CHEMICAL DEPENDENCY PROGRAM. MEDICATION LIST: ASPIRIN 81MG DAILY. CELEBREX 200 MG DAILY. THERAGRAN 1 TABLET. DEPAKOTE 500MG 3 TIMES DAILY. VALIUM 10 MG DAILY. MORPHINE SULFATE 15MG EVERY 8 HOURS. SEROQUEL 220MG DAILY. ULTRAM 50MG 3 TIMES DAILY. (B)(6) 2013- PSYCH CONTINUING CARE PLAN/DISCHARGE- DISCHARGE DIAGNOSIS- BIPOLAR DISORDER MOST RECENT EPISODE-MANIC WITH PSYCHOSIS. (CUT OFF) XX AND OPIATE DEPENDENCY. MEDICAL- CHRONIC PAIN SYNDROME, SEASONAL ALLERGIES. (B)(6) 2013- HISTORY, PHYSICAL AND ASSESSMENT SAME AS (B)(6) 2013. RETURNS TO DISCUSS PAIN. NEEDS HELP WITH FMLA PAPERWORK. ADMITTED TO HOSPITAL FOR BIPOLAR EPISODE SINCE LAST VISIT. DR. (B)(6) MANAGES ALL MEDICATIONS. PHYSICAL THERAPY PRESCRIBED. MEDICATION LISTS SAME AS (B)(6) 2013 WITH SOMA 350MG 1 TABLET TID ALSO LISTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 714704 | INFUSE BONE GRAFT | FILLER, RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEIN, COLLAGEN SCAFFOLD WITH MET | NEK | MEDTRONIC SOFAMOR DANEK USA, INC | NA | M114005AAF |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Required Intervention | INTERBODY CAGES, POSTERIOR INSTRUMENTATION |