Far-Lateral disk herniation: case report, review of the literature, and a description of nonsurgical management
Received 11 April 2002; received in revised form 10 June 2002
Abstract
Objective
To review the history and examination of a far-lateral lumbar intervertebral disk herniation (FLLIDH), as well as the treatment and outcomes of a nonsurgical approach.
Clinical features
A 60-year-old healthy male subject had a 3-week history of right buttock and calf pain. He initially had a left lateral list and asymmetrical pelvic landmarks. Range of motion (ROM) of the lumbar spine revealed full and pain-free lumbar flexion, right-sided pain with lumbar extension and left side bending, and painful and restricted left side bending. Neurologic examination was unremarkable.
Intervention and outcome
The patient was treated with a lumbar epidural and nerve root injection, as well as manipulation. Physical therapy consisted of deweighting treadmill, autotraction, and strengthening exercises. Outcomes were measured by using the Modified Oswestry Questionnaire, as well as a numerical pain rating scale. His initial Oswestry was 73%, pain 9/10 at presentation. Upon discharge, the Oswestry was 0% and pain was rated as 0/10.
Conclusion
A significant decrease was noted in both the Oswestry Questionnaire, as well as the pain rate. The patient returned to running on alternate days for a minimum of 30 minutes, which was his primary goal. This case demonstrated a positive outcome using a multidisciplinary approach in a patient diagnosed with a FLLIDH. He obtained his goals and his function was fully restored.
aAssistant Professor, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pa, USA
bAssociate Professor, Departments of Neurologic and Orthopaedic Surgery, School of Rehabilitative Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pa, USA
cAssistant Professor, Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, UPMC Health System, Pittsburgh, Pa, USA
dPhysical Therapist, University of Pittsburgh Medical Center, Center for Sports Medicine, Pittsburgh, Pa, USA
Submit requests for reprints to: Dr Richard Erhard, University of Pittsburgh, School of Health and Rehabilitation Services, 6035 Forbes Tower, Pittsburgh, PA 15260, USA
ABSTRACT