LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS
The lumbar facet joints are subject to wear-and-tear, particularly after a hyperextension injury that was not properly cared for. The ensuing chronic fixation leads invariably to Immobilisation Arthritis and Hyaline Cartilage degeneration.
IMMOBILISATION ARTHRITIS ... CASE FILELUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS
LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS
LUMBAR STENOSISLUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESISThe radiological report reads:"Forward slip of the body of L4 in relation to L5, spondylolisthesis, grade 1. At L4-5 a canal stenosis is seen with facet arthropathy and hypertrophy (thickening) of the Ligament Flavum. Reduced intervertebral foramena right more than links. At L5-S1 there is also relative canal stenosis, also on the basis of advanced facet arthropathy and hypertrophy of the Ligament Flavum. There is possibly a small synovial cyst at the left facet joint."
Certainly there is a very small, tight spinal canal, consistent with our case history and findings. Chronic low back pain, buttock pain and radiating pain to the left foot. Can Chiropractic possibly help? Does chiropractic help have a spinal stenosis explanation and solution...?
DISCUSSIONLUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESISSomething didn't quite fit. With such severe pain in the leg, I would in the first place have expected pain in the leg when she bent (either forwards, or sideways, backwards) and that the tests for a pinched nerve would be strongly positive. But no, this is not a "pinched" nerve in the normal sense, but irritated nerves, severely inflammed by the complex toxins exuded by fixated joints.We had to wait a week, before starting the treatment, for the X-rays and scan which brought forth the explanation. Extremely degenerate facet joints at L4-5 that had allowed the fourth lumbar vertebra to slide forwards: SPONDYLOLYSTHESIS. Interestingly her symptoms were partly from the S1 nerve root (from the L5 fixated joint) and partly from the L5 nerve root (tingling on top of her foot): from the Spondylolysthesis. The severe fixation in the right sacroiliac joint anatomy was central to the whole problem.
TREATMENTThe first three treatments involved the sacroiliac joints and L5 using the Thompson drop protocol, and gentle drop treatments on L5 with her in the side-lying posture. The pain increased after the first two treatments. She was dubious, but I assured her that was normal for a chronic condition.I modified the treatment to include the very degenerate L4-5 joint. From the case notes: "Flex iets Li bil. Kemp R en L > Links L5. L5R vast. ZSLR L licht in L bil. L4R, L5L roll drops. Steeds pijn, dus: Prone: R sac hard, L si AS hard. Supine R en L Si, ant bekken. Active release therapie aan de linker hamstring, piriformis en Iliotibial band." Within five treatment she had 50% less pain, and after seven the pain has completely gone. We are now busy with rehab, still concentrating on the right hip arthritis which is still tender, though also improving, and I'm pondering the need for a heel lift. Next week we start with a full examination of her neck, which is also stiff and painful.
PROGRESSLUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESISMrs G came in today for her seventh treatment. She's smiling, me too. She played tennis twice this week, with no ill effect. I'm no longer smiling! that wasn't allowed, but it seems with no negative results. She added a sentences about the loneliness of growing older. The tennis club is her solution. So be it, she's not just a back.The pain in her left leg has completely stopped and the Slump test is negative. She still has a little discomfort in the right sacroiliac joint, something she has had for years, which is connected to the arthritis in her right hip. The right groin is still a little painful when she rotates her hip. We're working on it, Rome wasn't built in a day. Nor were Aachen or Cologne as we say in Europe. (They are both worth a visit. Especially the Dom in Aachen is see the remains of Charlemagne, and the Christmas fair in Cologne. And the chocolate factory!) Managing these complex cases successfully means addressing each and every part of the syndrome. A mixture of symptoms and signs, in this case the
LOWER BACK AND LEG PAINLower back and leg pain is an every-day-event in chiropractic clinics. It's our bread and butter. Sometimes it's routine and straightforward, sometimes it can be extremely complex. Occasionally we have to refer patients for surgery. Occasionally!More often it's we who are trying to cope with very unhappy patients after Failed Back Surgery (FBS) as it's known in the literature, or the complications of surgery.
LOWER BACK AND LEG PAIN ... IMPORTANT CONSIDERATIONS @ LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESISReturn from LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS to LUMBAR FACET SYNDROME …Go from LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS to CHIROPRACTIC HELP home page … MONTHLY NEWSLETTER - sign up here...LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS
|
