Chiropractic & Pain Case Studies

Case 4

52 year old female
Referred by her PCP
Chief Complaint “Right Low Back and leg Pain”
Seen in consultation on 03/03/2017
Reported pain being there on and off for about a couple of years
Gradual recent worsening in the last couple months
No known trigger event.
Tried OTC NSAIDs, Massage, Acupuncture, Physical Therapy, Heating Pad, muscle relaxant (Flexeril)
Patient initially had relief from chiropractic care, but last couple treatments made her “worse” so she stopped going to her chiropractor
Patient has past medical history of cervical spine fusion (C5-6 ACDF).
After initial consultation with her PCP, MRI of the Lumbar spine was ordered and was “abnormal”.
The PCP recommended referral to a spine surgeon first. She express her desire to “try everything else first” and so she was referred to us.

Pain was described as “constant”, “continuous”, “numbing” and ”radiating down the leg”
Pain was rated average 6/10 VAS, max 9/10 VAS
Upon exam she was in no apparent distress upon rest
Tenderness present over the right low lumbar region
Facet loading maneuvers positive on the right
Straight leg raise test positive on the right
Motor exam normal, sensory suggestive of numbness to light touch and cold temperature in the right S1 dermatome

It depends

Was it the case here?

It depends

It depends

Right low back pain only which responds short term to the lumbar facet injections
Lumbar facet joint medial branch RFA
Lumbar radiculopathy which does not respond to combination of facet cyst injections and epidural steroid injections
Old fashion way:
- Lumbar laminectomy, facetectomy