OBJECTIVE: To report the clinical presentation and outcome of consecutive patients who received a course of nonoperative treatment, including manipulation, for low back and radiating leg pain. This review was conducted to generate hypotheses for a future clinical trial involving manipulation for the treatment of lumbar spine disk herniation.
DESIGN: A case series of consecutive patients presenting to a postgraduate teaching chiropractic clinic between 1990 and 1993 was evaluated. Three thousand, five hundred and fifty-three charts were reviewed; in 71 of the cases, the patient had low back pain (LBP) with radiating leg pain clinically diagnosed as lumbar spine disk herniation.
OUTCOME MEASURES: All outcome measures were extracted from the patients' charts. Subjective improvement reported by the patient, range of motion and nerve root tension signs were used to assess improvement.
RESULTS: Of the 59 patients who received a course of treatment, 90% reported improvement of their complaint. A subgroup analysis indicated that 75% of the patients that reported improvement of their conditions had an increase in straight leg raising (SLR) and lumbar range of motion. The maximum complication rate associated with this treatment approach was estimated to be 5% or less. A previous history of low back surgery was a statistically significant predictor of poor outcome.
CONCLUSION: Based on our results, we postulate that a course of nonoperative treatment including manipulation may be effective and safe for the treatment of back and radiating leg pain. This hypothesis remains to be tested in a prospective study.
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