Morris C E
Cleveland Chiropractic College, Los Angeles, California, USA.
J Manipulative Physiol Ther. 1999 Jan;22(1):38-44. doi: 10.1016/s0161-4754(99)70105-3.
To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 x 12 x 13 mm) L5-S1 disk herniation.
A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. His symptoms began 5 days before the initial visit and progressed despite nonsteroidal anti-inflammatory drugs and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. Magnetic resonance imaging demonstrated a large L5-S1 disk herniation.
Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. Counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation were provided to improve joint function. Sensory motor training, trunk stabilization exercises, and trigger point therapy were also used. He returned to modified work 27 days after symptom onset. A follow-up, comparative magnetic resonance imaging (MRI) study was unchanged. He was discharged as symptomatic (zero rating on both the Oswestry and numerical pain scales) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions.
This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation.
描述对因大型（12×12×13毫米）L5-S1椎间盘突出症导致的急性S1神经根病的非手术治疗。
一名31岁男性出现严重下背部疼痛，以及左腿疼痛、感觉异常和跖屈无力。其症状在初次就诊前5天开始，尽管服用了非甾体抗炎药和镇痛药，但仍有进展。检查发现左侧跟腱反射消失、左侧S1皮节感觉减退以及左侧腓肠肌/比目鱼肌无力。磁共振成像显示L5-S1椎间盘巨大突出。
该患者的初始治疗包括采用麦肯齐疗法进行俯卧撑起动作以减轻并使症状集中，进行非负重锻炼以增强心血管适应性，以及进行小腿等张运动以防止萎缩。提供了咨询服务以降低异常疾病行为风险。后来，采用了屈曲牵张和侧位手法治疗以改善关节功能。还使用了感觉运动训练、躯干稳定训练和触发点疗法。症状出现27天后他恢复了调整后的工作。后续的对比磁共振成像（MRI）研究显示病情无变化。50天后，经过20次就诊，他以症状消失（奥斯维斯特里功能障碍指数和数字疼痛量表均为零分）出院，尽管左侧S1反射仍然消失。169天后的重新评估显示既无明显症状，也无生活方式限制。
本病例证明了通过多模式疗法对与椎间盘突出相关的腰椎神经根病采用整脊康复策略的潜在益处。
