Objective: The purpose of this report is to describe the management of a patient experiencing post-surgical low back pain, secondary to a corrective thoracolumbar surgical fusion, as a consequence of traumatically-induced chronic cauda equina syndrome.
Clinical Features: A 59-year-old male with low back pain, buttock pain, anal hyperesthesia constipation, and urinary retention presented on consult for consideration of chiropractic care for low back pain. This patient was involved in a motorcycle collision 18-months prior, which resulted in a burst fracture of the first lumbar vertebral body, requiring corpectomy of L1 and spinal fusion T12-L2. This patient continued to have low back pain, chronic cauda equina syndrome with neurogenic bladder and perianal hyperesthesia following the spinal fusion. His residual neurologic defects were considered stable by his neurologist and primary care providers.
Intervention and Outcome: Care consisted of two separate trials of chiropractic care, totaling 13 visits over a 4-month period. The care provided to this patient included graded lumbosacral mobilization, thoracic, lumbar and sacral spinal manipulation, moist heat, and rehabilitation exercises. Following this course of care, the patient reported improvement of his low back pain.
Conclusion: In this case, management of post-surgical low back pain with concomitant chronic cauda equina syndrome responded favorably to a course of chiropractic care, over two separate trials, including spinal manipulation therapy.
Author affiliations: DJP: Staff Chiropractor, VA Northern California Health Care System; ALS: Staff Chiropractor, San Jose VA Medical Center
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