The X-Files: February 2007

Marshall Deltoff
January 04, 2008
Written by Marshall Deltoff
Welcome back to my colleagues and readers.  It is my hope that you and your families will have a year of health and success throughout 2007!  My sincere thanks goes out to Dr. Luc Roy, of St-Redempteur, Quebec, for the year’s first case.  Merci, Dr. Roy!
50Welcome back to my colleagues and readers.  It is my hope that you and your families will have a year of health and success throughout 2007!  My sincere thanks goes out to Dr. Luc Roy, of St-Redempteur, Quebec, for the year’s first case.  Merci, Dr. Roy!

This 19-year-old woman presented complaining of low back pain and numbness in both legs following long periods of standing.  She had recently increased her working hours as a salesperson during the holiday season, and she had to stand for hours on end during shifts.  She had no history of trauma, and had never before experienced low back pain or numbness.  The pain was described as a deep ache localized to the lumbar region and into the posterior thighs, with no other radiation.  No bowel or bladder problems were reported.  Palpation over the posterior joints from L4-S1 showed sensitivity.

Radiographs reveal a grade 5 spondylolisthesis of L5.  Note the “inverted Napolean hat” sign on the AP projection (Figure 1).  The lateral (Figures 2a+2b) demonstrates complete anteroinferior displacement of the L5 body off the sacral base (spondyloptosis)

The patient underwent treatment twice a week for the first month.  Each visit consisted of diversified adjustments and trigger point therapy.  The usual adjustments were lumbar rolls and either spinous push or pull.  Home exercises were prescribed from the Egoscue Method (squat on a rail, abdominal crunches, static wall and static back).  It was hoped that these exercises would aid in decreasing the extension stresses of the low back and hamstrings, and strengthen abdominals to aid in decreasing the hyperlordotic posture.  It was recommended to the patient that she sleep in the supine position with a pillow under her knees.  She was also instructed to avoid sitting for long periods of time, and to avoid lifting and bending at the waist.

After a very short trial of adjustments and the home exercise regime, the patient found that her pain was greatly relieved although her lower back occasionally gave some low-grade discomfort.

Dr. Roy hopes that this discussion will help some of his colleagues deal with spondylolisthesis patients.  Even though the radiograph is so dramatic, the patient responded very well to the chiropractic adjustments and exercises geared toward spondylolytic patients.

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