Chu Eric Chun-Pu, Yau Kristy Hoi-Ying, Bellin David Lawrence
New York Chiropractic and Physiotherapy Center, EC Healthcare.
Chiropractic Department, Kaifeng No.2 Hospital of Traditional Chinese Medicine.
Curr Health Sci J. 2023 Jan-Mar;49(1):129-133. doi: 10.12865/CHSJ.49.01.129. Epub 2023 Mar 31.
The key factors contributing to radiculopathy caused by lumbar disc herniation include mechanical compression. It was commonly believed that the disc herniation causes the compression on the nerve root exiting under the pedicle of the vertebral body at the adjacent inferior level. However, a disc herniation might occasionally result in non-adjacent, isolated radicular symptoms. We report the case of a 74-year-old female who presented with a 2-years history of progressive low back pain associated with L5 radiculopathy and reduced quality of life. The patient had undergone a magnetic resonance image showing a large L2/3 disc herniation. Symptoms had progressively worsened and failed to respond to conservative treatments including pain medication, exercise rehabilitation, and acupuncture at the lower lumbar region. The patient was diagnosed with L5 radiculopathy caused by L2/3 disc herniation. Consequently, her symptoms improved with chiropractic rehabilitation which involved spinal manipulative therapy and intermittent motorized traction at the L2/3 level to reduce herniated disc. Therefore, an L2/3 Disc herniation-related L5 radiculopathy should be considered in the differential diagnosis of cases of inconsistency of level of disc herniation and nerve root pattern.
导致腰椎间盘突出症引起神经根病的关键因素包括机械性压迫。人们通常认为，椎间盘突出会对相邻下椎体椎弓根下方穿出的神经根造成压迫。然而，椎间盘突出偶尔也可能导致非相邻的孤立性神经根症状。我们报告一例74岁女性病例，该患者有2年进行性下腰痛病史，伴有L5神经根病，生活质量下降。患者接受磁共振成像检查显示L2/3椎间盘巨大突出。症状逐渐加重，对包括止痛药、运动康复和下腰部针灸在内的保守治疗均无反应。该患者被诊断为L2/3椎间盘突出导致的L5神经根病。因此，通过脊椎按摩康复治疗，包括L2/3水平的脊柱手法治疗和间歇性电动牵引以减轻椎间盘突出，患者症状得到改善。因此，在椎间盘突出水平与神经根模式不一致的病例鉴别诊断中，应考虑L2/3椎间盘突出相关的L5神经根病。
