Federico E Villafañe1, Allison Harvey2, Norman Kettner1. 1. Department of Radiology, Logan University, Chesterfield, Missouri. 2. Department of Chiropractic Health Centers, Logan University, Chesterfield, Missouri.
Abstract
OBJECTIVE: The purpose of this case report is to describe the diagnostic imaging features of redundant nerve roots caused by chronic lumbar degenerative canal stenosis (CLDCS). CLINICAL FEATURES: A 56-year-old male presented with severe low back pain. He experienced pain during minimal active lumbar range of motion. The patient demonstrated weakness of the right iliopsoas and hypoesthesia of the L-2 dermatome. A working diagnosis of CLDCS was established. The patient's worsening severe low back pain warranted magnetic resonance imaging of the lumbar spine, which was performed for further evaluation. Magnetic resonance imaging demonstrated disk protrusion and canal stenosis with tortuosity of the cauda equina consistent with redundant nerve root appearance. INTERVENTION AND OUTCOME: The patient was treated with chiropractic flexion distraction, which was followed by a course of acupuncture and spinal manipulation. The patient self-discharged following clinical improvement. CONCLUSIONS: This case demonstrated CLDCS with associated redundant nerve roots. Conservative treatment included chiropractic diversified lumbar spinal manipulation, acupuncture, and electrical stimulation. The patient self-discharged following clinical improvement in 3 months.
OBJECTIVE: The purpose of this case report is to describe the diagnostic imaging features of redundant nerve roots caused by chronic lumbar degenerative canal stenosis (CLDCS). CLINICAL FEATURES: A 56-year-old male presented with severe low back pain. He experienced pain during minimal active lumbar range of motion. The patient demonstrated weakness of the right iliopsoas and hypoesthesia of the L-2 dermatome. A working diagnosis of CLDCS was established. The patient's worsening severe low back pain warranted magnetic resonance imaging of the lumbar spine, which was performed for further evaluation. Magnetic resonance imaging demonstrated disk protrusion and canal stenosis with tortuosity of the cauda equina consistent with redundant nerve root appearance. INTERVENTION AND OUTCOME: The patient was treated with chiropractic flexion distraction, which was followed by a course of acupuncture and spinal manipulation. The patient self-discharged following clinical improvement. CONCLUSIONS: This case demonstrated CLDCS with associated redundant nerve roots. Conservative treatment included chiropractic diversified lumbar spinal manipulation, acupuncture, and electrical stimulation. The patient self-discharged following clinical improvement in 3 months.
Authors: Carolina G Fritsch; Manuela L Ferreira; Christopher G Maher; Robert D Herbert; Rafael Z Pinto; Bart Koes; Paulo H Ferreira Journal: Eur Spine J Date: 2016-07-21 Impact factor: 3.134