Bergmann T F, Jongeward B V
Methods Department, Northwestern College of Chiropractic, Bloomington, MN 55431, USA.
J Manipulative Physiol Ther. 1998 May;21(4):288-94.
To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery.
The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation.
The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.
We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. Although significant questions remain for the evaluation and treatment of lumbar radiculopathy (sciatica) with disc herniations, there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.
探讨一例起源于椎间盘的伴有下背痛的坐骨神经痛病例。我们讨论将手法治疗作为一种保守方法的应用，并将其与其他保守方法及手术进行比较。
患者患有下背部和左腿疼痛，在6天内疼痛程度加重。左脚背和脚趾感觉减退。计算机断层扫描显示存在一个小的、局限的椎间盘突出。
患者最初接受冰敷，随后进行屈曲-牵引治疗。在她的前三次就诊过程中采用了这种治疗方法。一旦她疼痛减轻，就增加了侧位手法治疗。在她结束治疗前共需要9次治疗。
我们需要一种非手术的保守方法来治疗伴有坐骨神经痛的下背痛，作为更激进且可能有风险的手术治疗的替代方法及在手术治疗之前使用。有一些证据支持这样的观点，即伴有神经功能缺损和神经根性疼痛的腰椎间盘突出并不禁忌谨慎使用手法治疗。尽管对于伴有椎间盘突出的腰椎神经根病（坐骨神经痛）的评估和治疗仍存在重大问题，但有充分证据表明，在考虑手术咨询之前，应先完成包括脊柱手法治疗在内的保守治疗疗程。
