Spinal Manipulation and Therapeutic Exercises in Treating Post-Surgical Resurgent Lumbar Radiculopathy
Francio, Vinicius TieppoDavani, Saeid et al.
Archives of Physical Medicine and Rehabilitation , Volume 98 , Issue 10 , e18 – e19
Research Objectives: To educate clinicians about the benefits of spinal manipulation and therapeutic exercises in cases of post-surgical lumbar radiculopathy, which is consider a relative contra-indication, successfullyused in this case. Lumbar radiculopathy due to disc herniation is one of the most common conditions seen in spine care practices worldwide. Surgical intervention is often necessary, and most patients improve without reoccurrences. The purpose of this case is to describe the successful outcome of post-surgical resurgent lumbar radiculopathy treated with spinal manipulation and therapeutic exercises.
Design: Case report study.
Setting: Multidisciplinary spine center.
Participants: One case.
Interventions: Spinal manipulation and therapeutic exercises (McKenzie extension based program).
Main Outcome Measure(s): This case reports a 42-year-old male who presented to the spine center with acute lower back pain and left sided radiculopathy associated to a history of lumbar laminectomy one year earlier. Left sided seated straight leg raiser (SLR) was positive. Sensation was slightly decreased with light touch along the L5 dermatome at the dorsum of the left foot. Updated lumbar spine MRI revealed post surgical laminectomy morphological changes, with lumbar disc degenerative disease and disc bulging,and neuroforaminal with central canal narrowing.
Results: The patient received twelve treatments of manipulative medicine, twice a week in a six-week period, as primary intervention, in addition to therapeutic McKenzie Method exercises. By the end of the treatment plan, the patient was asymptomatic. Outcome assessment score (Oswestry) showed an 89% improvement. In a three-month follow up, he remained stable. Conclusions: This case reports a successful outcome and the worthiness of considering spinal manipulation and McKenzie therapeutic exercises in patients suffering from resurgent lumbar radiculopathy, even when postsurgical changes are present, if there are no absolute contra-indications. This is a cost and clinically effective method to prevent further expenses, unnecessary procedures and improve patient’s outcomes to prevent further musculoskeletal disabilities.
Key Words: Lumbar radiculopathy, Lumbar laminectomy, Rehabilitation, Spinal manipulation, Complementary and Integrative methods Disclosures: Manuscript under second revision at the Oxford Medical Case Reports Journals.