Severe Low Back Pain and Bilateral Radiculopathy from Advanced Lumbar Degenerative Disease with Large L4/L5 Disc Extrusion: A Chiropractic Case Report Emphasising MRI Interpretation and Co-Management

A woman in her 60s with 20 years of intermittent low back pain presented with severe low back and bilateral leg pain of two months' duration unresponsive to conservative care. Examination revealed severely restricted lumbar motion, positive nerve tension tests, and bilateral paraspinal spasm. Radiographs showed grade 2 L4/L5 anterolisthesis and degenerative changes. After four weeks of multimodal chiropractic care produced minimal improvement, lumbar magnetic resonance imaging demonstrated large L4/L5 disc extrusion with cranial migration, facet synovial cyst, severe central canal and foraminal stenosis bilaterally, and multilevel degeneration. The chiropractor independently reviewed the lumbar magnetic resonance imaging, confirmed findings, and urgently referred for neurosurgical evaluation. The patient underwent L4/L5 decompression and fusion with marked symptom improvement. This case emphasises MRI interpretation competency and timely surgical co-management by primary spine care chiropractors.