Far-lateral disk herniation: case report, review of the literature, and a description of nonsurgical management

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. 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 asy...

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Bibliographic Details
Published in:Journal of manipulative and physiological therapeutics 2004-02, Vol.27 (2), p.e3-e3
Main Authors: Erhard, Richard E, Welch, William C, Liu, Betty, Vignovic, M
Format: Article
Language:English
Subjects:
Humans
Injections, Epidural
Intervertebral Disc Displacement - physiopathology
Intervertebral Disc Displacement - rehabilitation
Lumbar Vertebrae - physiopathology
Male
Manipulation, Spinal - methods
Middle Aged
Radiculopathy - physiopathology
Radiculopathy - rehabilitation
Range of Motion, Articular
Spinal Nerve Roots - drug effects
Time Factors
Treatment Outcome
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Summary: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. 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. 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. 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.
ISSN:0161-4754