This report discusses a case of a 50-year-old male complaining of a two month history of severe lower back pain with progression to left sided sciatica. The patient had sought previous consult with medical physicians, chiropractors and an acupuncturist. The various attempts of muscle relaxants, pharmaceuticals, specific chiropractic manipulative techniques, and acupuncture provided did not offer significant results.
During this trial of divergent care, plain film radiographs and MR images of the lumbar spine were obtained. The radiographs were performed in the weight-bearing position and included anteroposterior and lateral projections. They revealed a slight levorotatory lumbar scoliosis and significant flattening of the lumbar lordosis. These films suggest an acute clinical presentation. The disc space at L5/S1 demonstrated approximately 50% loss of height; no other signs of degenerative change were seen (i.e. sclerosis, spondylophytosis) (Fig. 2). The MRI was performed on an upright unit and the images were taken in the neutral seated (weight-bearing) position using standard imaging protocols. The T1- and T2-weighted sagittal and axial images were reviewed by a chiropractic radiologist and collectively revealed discal dehydration and desiccation at the L4/5 level with underlying degenerative bulging of the disc. There was no disc herniation at this level. A left paracentral disc herniation (extrusion) was present at the L5/S1 level, which posterolaterally displaced the left
S1 nerve root. An area of bright signal intensity within the disc herniation represents an annular tear. There was approximately 50% loss of disc height at the same level with a corresponding degenerative loss of signal intensity and evidence of discal desiccation (Fig. 3A and B).
The patient considered an epidural injection in lieu of his previous two month failure of conservative and pharmaceutical trials. However, in an attempt to exhaust all noninvasive measures, a trial of spinal decompression therapy utilizing the DRX-9000 was sought. The orthopedic examination prior to decompression therapy was difficult due to the patients’ pain. Straight Leg Raising test, Fabre’s test, double leg raising, as well as Linder’s orthopedic maneuvers could not be performed due to pain. The limited orthopedic results confirmed lower back motion sensitivity with periodic shooting pains into the posterior aspect of the left leg. There was no abdominal pain, no noted change in bowel or bladder control and the neurological examination revealed no lower extremity paraesthesias.
Without evidence of contraindication for spinal decompression therapy, the patient was recommended to receive 20 sessions of spinal decompression on a DRX-9000 unit. Therapy protocol consisted of treatments three times per week for four weeks and then two times per week for four weeks with decompression sessions of 14 cycle increments.
Decompression was followed by 15 minutes of myofascial work and then 15 minutes of cryotherapy (cold packs) kept at a constant circulating temperature between 40 to 50 degrees Fahrenheit.
The patient’s job entailed much travel and only seven decompressions were provided at the examining doctors’ office; however, the patient continued treatment at various doctors within North America utilizing the DRX-9000 unit. These treatments were applied in five differing cities by five different doctors of chiropractic. Each differing doctor provided two sessions. Treatment protocols have been established by the distributor of the DRX-9000 (Axiom Worldwide) and we were advised these protocols were followed at the various locations, thus allowing consistent maintenance of this patient’s care.
The seven treatments occurring at the prescribing doctor’s office are outlined in Table 1. The force applied was based on the patient’s weight of 125 lbs. Relief of radicular symptoms began following the first treatment, and eight weeks of follow-up care provided 100% reduction of all lower back and leg complaints. Approximately 7.5 months following the initial date of treatment, MRI re-evaluation of the patient’s lumbar spine was obtained. These scans were performed at the same imaging center and using the same standard imaging protocols for a neutral seated (weightbearing) position. The images were read by a medical radiologist. The scans through the L5/S1 level demonstrated mild decreased signal intensity within the disc consistent with desiccation and degenerative change, as well as a complete resolution of the previous paracentral extruded disc herniation. There is no longer evidence of thecal sac deformation or displacement of the S1 nerve root (Fig. 4A and B). The patient denies lower back or sciatic pain recurrence since spinal decompressive treatments.
(Fig. 4A and B) The patient denies lower back or sciatic pain recurrence since spinal decompressive treatments.