Chiropractic and Rehabilitative Management of a Patient With Progressive Lumbar Disk Injury, Spondylolisthesis, and Spondyloptosis

OBJECTIVE: To describe the chiropractic treatment for a patient with low back pain accompanied by sensory and motor deficits of his left leg and magnetic resonance imaging-documented lumbar spinal cord and nerve root impingement. CLINICAL FEATURES: A 57-year-old man experienced low back pain that radiated into his left leg and subsequently produced both sensory and motor deficits of the left thigh and quadriceps followed by a similar weakness and accompanying paresthesia of the lower left leg. Onsets were sudden and occurred during sleep, after prolonged sitting or during long periods of driving. Diagnostic studies revealed a slight impingement at the L5-S1 level due to anterior displacement of the L5 vertebra and a mild protrusion of the L4 disk. INTERVENTION AND OUTCOMES: Treatment consisted of chiropractic spinal manipulation, physical therapy modalities, and rehabilitative exercises. Outcome measurements in his case indicated that his rehabilitation was appropriate. CONCLUSION: There is an abundance of published reports describing treatment of disk injury, low back pain, and spondylolisthesis with a variety of manipulative methods. However, this appears to be the first case reported in indexed literature of a progressive multilevel lumbar disk injury with concomitant spondylolisthesis and spondyloptosis.