Passive care and active rehabilitation in a patient with failed back surgery syndrome.

OBJECTIVE

To describe the results of chiropractic care combined with rehabilitative exercise protocol for a 41-yr-old male patient suffering from failed back surgery syndrome.

CLINICAL FEATURES

A 41-yr-old man, who herniated his L4-L5 disc 4 yr before presentation and had undergone two surgeries to relieve his symptoms, sought chiropractic care for complaints of chronic, severe low back pain and leg pain with sensorimotor deficits.

INTERVENTION AND OUTCOME

A 16-wk treatment protocol coupled passive chiropractic care (including adjustment, electric stimulation, stretching, massage and moist hot packs), with active rehabilitative exercise (including pelvic stabilization, muscle strengthening, proprioceptive training and movement training). Outcome measures included weekly assessment of the patient's active thoracolumbar flexion and extension by a goniometer. The Low Back Pain and Disability Questionnaire (Revised Oswestry) and visual analogue pain scale were administered weekly. In addition, daily activities such as ability to walk without a cane and hours of painfree sleep per night were noted each visit. After 16 wk of care, thoracolumbar ranges of motion were restored to normal, pain was reduced from "severe" to "moderate" and ability to perform daily activities was increased. The patient no longer required a cane to walk and was able to walk up to 7 miles without difficulty. Sleep increased from 5 to 7-9 hours per night. The patient halted use of pain medications, except for occasional days when he felt a significant increase in pain.

CONCLUSION

A multifactorial treatment approach using passive care plus active rehabilitative exercises can be effective in the treatment of chronic low back pain associated with failed back surgery syndrome. Chiropractors who are trained in rehabilitation techniques will be well prepared to provide comprehensive care to such patients.