Brenner Alexander Karl
Physical Therapy Services, US Army Vicenza Health Clinic, Vicenza, Italy.
J Orthop Sports Phys Ther. 2005 Jun;35(6):368-76. doi: 10.2519/jospt.2005.35.6.368.
Case report.
A lumbosacral transitional vertebra (LTV) is a congenital anomaly that occurs in 3% to 21% of people with and without low back pain (LBP). There is lack of agreement in the literature as to whether or not the presence of a LTV may cause LBP. The objective of this case report is to present the use of lumbosacral region manipulation and therapeutic exercises on a patient with a known LTV and LBP.
In this case report, an active-duty US Army soldier was referred to physical therapy with right-sided LBP and a lumbar radiograph showing a hemisacralized transitional L5 vertebra on the same side as his pain. The patient was treated with lumbosacral region manipulation and flexion exercises aimed at regaining total spinal motion and reducing pain. The patient responded favorably to spinal manipulation and exercise and was discharged from physical therapy after 4 visits. A modified Oswestry Low Back Pain Disability Questionnaire and inclinometer were used to measure outcome after physical therapy intervention.
After a 2-week period of treatment in physical therapy, the patient improved from an initial Oswestry score of 32% to a score of 4%. Forward bending and left side bending improved from 74 degrees to 140 degrees and from 21 degrees to 45 degrees, respectively.
Lumbosacral region manipulation along with therapeutic exercises appears to have been an effective treatment approach for this patient with LBP associated with a type IIA LTV.
病例报告。
腰骶部移行椎（LTV）是一种先天性异常，在有或无下腰痛（LBP）的人群中发生率为3%至21%。关于LTV的存在是否会导致LBP，文献中尚无定论。本病例报告的目的是介绍对一名已知患有LTV和LBP的患者进行腰骶部区域手法治疗和治疗性锻炼的情况。
在本病例报告中，一名现役美国陆军士兵因右侧LBP被转诊至物理治疗科，腰椎X线片显示其疼痛侧的L5椎体为半骶化移行椎。对该患者进行了腰骶部区域手法治疗和旨在恢复脊柱整体活动度及减轻疼痛的屈曲锻炼。患者对脊柱手法治疗和锻炼反应良好，经过4次就诊后从物理治疗中出院。使用改良的奥斯维斯特里下腰痛残疾问卷和倾角仪来测量物理治疗干预后的结果。
经过两周的物理治疗，患者的奥斯维斯特里初始评分从32%提高到了4%。前屈和左侧弯分别从74度改善到140度以及从21度改善到45度。
腰骶部区域手法治疗以及治疗性锻炼似乎是治疗该患有与IIA型LTV相关LBP患者的有效方法。
