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Spinal Decompression Case Studies A collection of articles by Dr. Larry Van Such – Vol. 1 Subject: 37 year old male. Diagnosis: Circumferential Disc Bulge L4/L5 History: Patient presents with lower back pain radiating into left leg and left groin region upon his initial visit into my office on Prior Treatment and Effects: Patient seen his family doctor in October 2004. Initially prescribed Flexoril, Naproxen, and Vicodin. Patient rated his pain prior to taking medications as a 10 out of 10 with a 10 being the highest level of pain. Began taking medications for several months and reported no change in sypmptoms. 1) Referred out for MRI on Normal alignment of the lumbar spine. The vertebral bodies are of normal height with no compression fracture. Conus Medullaris is of normal position and appearance. L5-S1: L4-L5: L3-L4: L2-L3: L1-L2: T12-L1: There is no facet arthropathy. CONCLUSION: Shallow circumferential disc bulge at L4-L5 with no compressive discopathy. See above comments for additional details and pertinent negatives. 2) Medical doctor refers patient out for six weeks of physical therapy. Patient reports an increase in symptoms and a new symptom (painful urination) after two therapy sessions as stops going. 3) Returns to medical doctor who refers him out to urologist. Urologist finds nothing wrong with his genitor-urinary system and relates symptoms to disc bulge at L4-L5. Makes recommendation to see orthopedic surgeon. 4) Patient schedule consultation with orthopedic surgeon in May of 2005. Recommends surgery and schedules him for operation in July of 2005. Patient insists he does not want surgery and releases himself from all care. Current Treatment and Status: Patient enters my office on Treatment Plan: Current treatment plan is to treat the patient three times a week for six weeks. Patient is very good about keeping appointments, however, he is in a lot of pain and asks many questions, mostly regarding his referred pain into his groin. This is his number one concern. I explain to him the anatomy and exactly what a circumferential disc bulge is. This is a very unique case in that the bulge is not just toward one particular side, but rather completely around the disc. This is why he has very strange feelings of pain and discomfort that he says is hard to explain. After one month of care on After two months of care on On April 3, 2007, patient has another MRI performed: The following are the findings: Sagittal images demonstrate normal vertebral bodies and intervertebral discs. The facets appear to be intact. No spondylolysis is appreciated. No degenerative anterolisthesis or retrolisthesis is seen. No central or lateral recess or foraminal encroachment is identified with no nerve root compromise seen. No intradural lesions are appreciated with normal cord ending at T12-L1. The paravertebral soft tissues are unremarkable. Impression: After four months of Care in May of 2007, patient is released from care. Very excited and goes back to work without restrictions. |