Objective: This case report describes the effect of Cox flexion-distraction manipulation on a patient with a symptomatic L4-L5 extruded disc above an L5-S1 spondylolytic spondylolisthesis.
Clinical Features: A 40-year-old man presented to a chiropractor with complaints of acute low back pain and stiffness with pain and tingling radiating into the left leg and foot. Plain-film radiography revealed bilateral pars defects at L5, and magnetic resonance imaging revealed the L4-L5 disc extrusion.
Intervention and Outcome: Treatment consisted solely of Cox flexion-distraction for a total of 9 visits over a period of 4 weeks. The pain was assessed initially and at the end of care using a numeric scale of 0 to 10. At treatment conclusion, the original low back and radicular-type symptoms were no longer present, and the patient rated the pain as a 0 after an initial pain assessment of 9 on the 0-10 scale. After 10 years, a follow-up examination showed no orthopedic or neurologic deficits and no recurrence of the original symptoms.
Conclusion: This patient responded favorably to the chiropractic treatment provided. Cox flexion-distraction manipulation may be a viable nonsurgical treatment for similar symptomatic individuals with disc extrusions and concurrent spondylolytic spondylolisthesis.
Author keywords: Low Back Pain; Sciatica; Manipulation; Chiropractic; Spondylolisthesis
Author affiliations: RAK, BAW: Keiser University College of Chiropractic Medicine, West Palm Beach, Florida, United States; SG: Chiropractic Care, Ltd., Chicago, Illiois, United States
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