Index to Chiropractic Literature
Index to Chiropractic Literature
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ID 20759
  Title Failed back surgical syndrome - L1-2 and L5-S1 disc herniations following L4- S1 spinal fusion: A case report [case report]
Journal J Acad Chiropr Orthoped (JACO). 2009 Sep;6(3):Online access only p
Peer Review Yes
Publication Type Case Report

Purpose: Spinal surgery and fusion procedures for spinal stenosis, disc herniation, and instability have increased consistently. Patients are often left with equal or worsening post-surgical pain. This case report presents a failed back surgical patient who was successfully treated with specialized flexion distraction and decompression chiropractic manipulation. Such failed back surgical cases are an increasing challenge to chiropractic practitioners due to their increasing number and severity seeking chiropractic care.

Methods: Cox® flexion distraction decompression spinal manipulation, electrical stimulation, back school training and ergonomic exercises were used as the treatment of a large subligamentous and lateral recess L1-L2 disc herniation and an L5-S1 central disc protrusion subsequent to a rod and bolt and intertransverse process fusion from L4-S1 for sciatic radiculopathy . Also following the lumbar spine surgery, the patient developed bilateral radicular arm pain which was confirmed on MRI demonstrating three level cervical disc herniation. This also required flexion distraction and decompression spinal manipulation at the same period of clinical care for the lumbar disc herniations. Visual analogue scale and Oswestry low back disability questionnaire were used as the subjective evaluators of clinical outcome.

Result: Total relief of bilateral sciatic radiculopathy, right upper extremity radiculopathy and greater than fifty percent relief of low back pain was attained in this failed back surgical case. Only moderate left arm radiculopathy persisted depending upon patient work load and failure to continue spinal manipulation and home exercises.

Conclusion: This failed back surgical patient gained total relief of bilateral lower extremity radiculopathy and over 50% relief of low back pain subsequent to lumbar spine surgical fusion. She also escaped a cervical spine discectomy for bilateral upper extremity radiculopathy due to the clinical syndrome and MRI confirmed three level disc herniations. Flexion distraction decompression spinal adjustment, electrical modalities, back school and exercises were the treatment methods employed.

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