Clinical Scenario

DOI: 09/12/2014. Patient is a 45-year-old male vacation relief route sales representative who sustained a work-related injury to his lumbar spine from bending and pulling a bread product. Per OMNI entry, he was initially diagnosed with disc herniation at L4 to L5 with radiculopathy. He is status post extraforaminal L4 to L5 discectomy on 04/09/2015. He has been off work for nearly 2 years.

The patient was compliant to all aspects of treatment and the home exercise program. There are no known alternate explanations of the outcomes of this case report. However, in comparison to the case report by Caldwell et al25., the patient in this case report displayed a faster decrease in pain and return to normal function indicated by 0/10 VAS, 0% neck disability and ability to perform all tasks for work at the last day of treatment, 3 weeks from the first day of physical therapy. Possible explanations for the faster recovery could be due to the slight difference of impairments as well as the addition to grade IV and V manipulations to the cervical and thoracic spine as suggested to have high correlation with decrease in pain and normalization

Ultimately, continue with gait and balance training of the patient. In the beginning recommend patient to walk with walker and discontinue it when he recovers fully. For back pain, we have to check radiographs of the low back for deformity at any vertebral level and to check exaggerated or loss of curvatures. In this clinical case there is no any radio imaging findings and the back pain is all due to muscle spasms. For treating muscle spasm we will use heating packs.

Usually a herniated disc heals on its own. So most of the time nonsurgical treatment is tried first

Otherwise, the muscles in your back will stiffen and prolong the problem. Using a heating pad can be helpful in relaxing the muscle and alleviate the pain. Although, a doctor can prescribe medication to cut down the inflammation, the most effective and long term solution is physical therapy. A physical therapist will be able to teach you movements that can make your back muscles stronger which will in turn prevent future injuries. Other preventative methods to avoid a herniated disc includes: proper lifting techniques such as bending knees and squatting while lifting heavy boxes. Regular exercises and a good posture can also prevent strain on your back or whenever your spine is weak. Staying healthy and controlling weight, and consistently exercising can also lessen the possibility of a herniated disc. Unhealthy behavior such as smoking also increases the risk of an injured disc because smoking accelerates the aging process of the bone and decreases the circulating of oxygen to the

Non-occupational lifting was also studied as a risk factor for herniated lumbar intervertebral disc (Mundt et al. 1993). For this study, 287 patients with symptoms of herniated lumbar disc were involved and compared with control subjects without back pain taking in consideration the age, sex, source of care and geographic area. Based on their data, they showed that the risk of herniated

After 27 physical therapy visits post surgeries in a period of 6 months the patient reported no perceived disability to work after 52 weeks. Although, some functional disability was experienced when it came to general activities and sports between 4 to 13 percent based on the QuickDASH. Pain levels reported by the VAS remained considerable low. The subject reported pain level between 0-4 on a 10 scale; pain decreased to zero by week 10.

The results of this study show that both treatment interventions are just as effective in pain reduction and increased spinal mobility following a single treatment. A post boc correlation (relationship between variables) analysis was performed in order to explore the relationship between changes in pain and lumbar extension motion. Researchers analyzed the relationship between an increase in motion and decrease in pain for this study.

Search strategies for this review will be established to access both published and unpublished materials. Firstly, a search of the literatures will be conducted using numerous online databases. Similarly, a range of research methods that assist in finding appropriate journal articles will be utilised. These include consideration about which topics that most define chronic low back pain management and different interventions used for management of this condition. Further, to ensure whether the study is appropriate and relevant to the research question, both an inclusion and exclusion criteria will be considered. Thus, articles will be included if they meet the following principles: published between 2002 and 2016, articles related to nursing and health professionals, and written in the English language and Peer-reviewed articles as well.

Selective Endoscopic Discectomy (or Percutaneous Discectomy Microdecompressive Endoscopic Lumbar Discectomy with Laser Thermodiskoplasty) is a new procedure to shrink and remove herniated disc.Using local anesthesia and the help of x-rays for guidance, specially designed micro-instruments, the discectome and a laser probe are inserted into the herniated disc space and the disc is removed by suction, and then shrunk by the laser, instead of the open surgery. Selective Endoscopic Discectomy is different from standard lumbar disc surgery because there is no muscle dissection or bone removal. There is only one tiny incision to accommodate the micro-instruments, inserted into the herniated disc. Most complications that occur with surgery are eliminated

For the treatment of lumbar disc herniation or radicular pain various con¬servative, surgical or nonsurgical methods have been used. Conservative method such as rest, analgesics, traction, medication, physical therapy, structured exercise etc. are used which are effective only for mild to moderate cases, then the injections can be tried and may offer rapid relief from pain in acute patients and may be a good treatment alternative for patients and the last hope is surgery but surgery has its own limitations, as it is a costly procedure, and may have several post-operative complications, chronic pain, and persistent disability. However, surgery is not available for everyone who is symptomatic, and may lead to failure in near about 25% of patients

we found an apparent clinico - radiological discrepancy between sciatica described by patients on one side and MRI finding on the other side without any other abnormality. The cases of foraminal herniated disc were excluded. In the event of any doubt regarding presence of differential diagnosis of sciatica other than disc herniation and when there was no in - dication for emergency surgery, patients were referred to neurologists and rheumatologists to rule out any other differential diagnosis such as peripheral neuritis, diabetic polyneuropathy, sensory-motor mixed neuropathy, or other rheumatological and neurological diseases. In this paper, we aimed to estimate

Abstract: Background: Lumbar disc herniation surgical techniques have greatly evolved over the last 30 years in terms of instrumentation. Percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) were both commonly used today, whereas which one is more competent are still debated. As we know, there are very less articles in this field. Methods: The data bases, including PubMed, Web of Science, Embase, Cochrane Library, Wanfang, and CNKI were used for a literature search. The references of each selected articles were also manual checked. The outcomes we were interested in were divided into primary ones and secondary ones. High quality articles were separated from selected articles for sensitivity analysis and the

After 27 physical therapy visits post surgeries in a period of 6 months the patient reported no perceived work disability after 52 weeks. Nonetheless, some functional disability was experienced when it came to general activities and sports between 4 to 13 percent based on the QuickDASH. Pain levels reported by the VAS remained considerable low. The subject reported the pain level between 0-4 on a 10 scale; pain decreased to zero by week 10.

A 28 year old female presented to our institution with a three-month history of right sciatic pain in the S1 distribution. She was initially treated conservatively with analgesia and physiotherapy, however her pain continued despite these interventions. She had no weakness or bowel or bladder symptoms. On examination she had a positive Lasegue?s test at 30 degrees on the right. No motor of sensory deficits were found. A lumbar Magnetic Resonance Image (MRI) scan done showed a paracentral disc bulge at L5/S1 impacting the traversing right S1 nerve root, and exit foraminal stenosis (Fig 1). She was taken to the