Erhard Richard E, Welch William C, Liu Betty, Vignovic M
Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA 15260, USA.
J Manipulative Physiol Ther. 2004 Feb;27(2):e3. doi: 10.1016/j.jmpt.2003.12.007.
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.
回顾极外侧腰椎间盘突出症（FLLIDH）的病史及检查情况，以及非手术治疗方法及其效果。
一名60岁健康男性患者有3周的右臀部和小腿疼痛病史。他最初有左侧侧弯及骨盆标志不对称。腰椎活动范围（ROM）显示腰椎前屈完全且无疼痛，后伸及左侧弯时右侧疼痛，左侧弯疼痛且受限。神经系统检查无异常。
该患者接受了腰椎硬膜外及神经根注射以及手法治疗。物理治疗包括减重跑步机训练、自动牵引及强化锻炼。通过改良奥斯维斯特问卷（Modified Oswestry Questionnaire）及数字疼痛评分量表来衡量治疗效果。他最初的奥斯维斯特评分为73%，就诊时疼痛评分为9/10。出院时，奥斯维斯特评分为0%，疼痛评分为0/10。
奥斯维斯特问卷评分及疼痛率均显著降低。患者恢复了隔天跑步至少30分钟，这是他的主要目标。该病例表明，对一名诊断为FLLIDH的患者采用多学科方法取得了积极效果。他实现了目标，功能完全恢复。
