Abstract

Lumbar Spinal Stenosis (LSS) is a condition of the lower back resulting in a variety of pathological symptoms such as pain, weakness, and/or paresthesia that impacts millions of people worldwide. Several conservative treatment options are available for LSS as an alternative to surgery or spinal injections including physical therapy, Spinal Manipulative Therapy (SMT), and acupuncture. The purpose of this case report was to describe the treatment of an older Veteran with lumbar spinal stenosis utilizing one of these conservative interventions: flexion-distraction SMT. A 68-year-old male Veteran of the US military presented to the chiropractic clinic with several years of lower back pain and lower extremity pain. Prior interventions such as injections and pharmaceutical medications had minimal positive changes. Imaging demonstrated central canal and neural foraminal stenosis along with extensive degenerative changes in the lumbar elements. The patient had poor mobility and limited range of motion in the lumbar region. Physical exam concluded the pain and symptoms were a result of lumbar spinal stenosis. A trial of conservative SMT including flexion-distraction was initiated. After 6 treatments the patient demonstrated reduced pain, increased mobility, and felt the condition was overall improved. For mobility measurement, the University of Alabama at Birmingham Life Space Assessment was utilized. This assessment has novel use for investigating mobility and manual therapy and this case report may serve as starting point for future investigations. In conclusion, flexion-distraction SMT was a beneficial conservative treatment option for an older Veteran with lumbar spinal stenosis that prevented the need for surgical or further pharmaceutical interventions.

Keywords:Chiropractic; Low back pain; Lumbar spinal stenosis; Spinal manipulation; Veteran; Conservative care

Abbreviations: CTFD- Cox Technic Flexion Distraction; FD- Flexion-Distraction; LBP- Low Back Pain; LE’s- Lower Extremities; LSA- Life Space Assessment; LSS- Lumbar Spinal Stenosis; MRI-Magnetic Resonance Imaging; N/A- Not Available; NRS- Numerical Rating Scale; PT-Physical therapy; SMT- Spinal Manipulative Therapy