Chiropractic & Pain Case Studies

Case 1

  • 52 year old female

  • Referred by her PCP

  • Chief Complaint “Right Low Back and leg Pain”

  • Seen in consultation on 03/03/2017

  • Reported pain being there on and off for about a couple of years

  • Gradual recent worsening in the last couple months

  • No known trigger event.

  • Tried OTC NSAIDs, Massage, Acupuncture, Physical Therapy, Heating Pad, muscle relaxant (Flexeril)

  • Patient initially had relief from chiropractic care, but last couple treatments made her “worse” so she stopped going to her chiropractor

  • Patient has past medical history of cervical spine fusion (C5-6 ACDF).

  • After initial consultation with her PCP, MRI of the Lumbar spine was ordered and was “abnormal”.

  • The PCP recommended referral to a spine surgeon first. She express her desire to “try everything else first” and so she was referred to us.

  • Pain was described as “constant”, “continuous”, “numbing” and ”radiating down the leg”

  • Pain was rated average 6/10 VAS, max 9/10 VAS

  • Upon exam she was in no apparent distress upon rest

  • Tenderness present over the right low lumbar region

  • Facet loading maneuvers positive on the right

  • Straight leg raise test positive on the right

  • Motor exam normal, sensory suggestive of numbness to light touch and cold temperature in the right S1 dermatome


Interlaminar Epidural Steroid Injection

diagnostic report

Interlaminar Epidural Steroid Injection

Transforaminal Epidural Steroid Injection

Lumbar Radiofrequency Neurotomy (Rhizotomy)

pain blocked

Facet Joint Injection

  • On 03/07/2017 the patient underwent:

  1. Right L5/S1 facet aspiration and injection with steroids

  2. Right L5 and S1 transforaminal epidural steroid injection

  • Question:

    • Can mobilizing a facet joint that has arthritis and an adjacent facet cyst temporarily irritate a nerve root?

    • Was it the case here?

  • Question:

    • What if the patient does not get good and/or sustained relief from combination if epidural steroid injections and facet injections?

  • Answer:

    • It depends

  • Right low back pain only which responds short term to the lumbar facet injections >

    • Lumbar facet joint medial branch RFA​

  • Lumbar radiculopathy which does not respond to combination of facet cyst injections and epidural steroid injections

  • Old fashion way:

    • Lumbar laminectomy, facetectomy​


Old Approach: Big Surgery Laminectomy


Old Approach: Big Surgery Laminectomy

enlarged facet joint

Old Approach: Big Surgery Laminectomy

screw rod

Surgical Options

Adjacent level disease

down the road

Down the Road…


Alternative: Ultra Minimally Invasive Approach

A Different Approach


Transforaminal Approach

Endoscopic Discectomy Approaches Interlaminar vs Transforaminal


Transforaminal vs Interlaminar