Case of the Week – Severe low back degeneration

55-year-old male patient presents with significant numbness of the outside of the left lower leg and foot, history of falls, mild lower back pain.  Surgical history notable for a disc surgery 20 years in the past, due to lower back and left leg pain. 

MRI and X-rays find severe degenerative arthritis and disc space loss at the two lowest levels in the patient’s lower back, as well as degenerative arthritis in the left knee. 

Physical examination is notable for a man who walks with a very pronounced hitch in his left leg gait.  Also notable for loss of sensation to pin prick and light touch over much of the lateral calf, the outside of the foot and the big toe.  Knee and ankle reflexes are both diminished.  Measurements of the left calf girth confirm loss of mass comparative to right (atrophy).

Referrals are made to neurology for further work-up.  In the meantime it is decided to embark upon a course of conservative care with the stated goal of potentially slowing the progression of the lumbar degenerative disc disease, the resulting atrophy and loss of sensation.

Six visits are scheduled with treatment measures including mild manual (doctor-assisted) traction, massage, mechanical chiropractic adjustments, along with instruction in exercises, diet and stretching.  The patient was advised to lose 10-15 pounds.

Current progress: Now into the third week of care, four visits, the patient has reported feeling intermittent pain in a formerly numb area of his left foot.  His left leg continues to feel week, but he has been able to ride an exercise cycle and is walking 3-4 blocks daily without falling.  These are positive signs. 

 The patient will consult with neurology as recommended, to see what they suggest, but in the meanwhile is gaining strength in his weak, atrophied leg, appearas to be maintaining his health, as well as showing a glimmer of restored sensation, even if it is ‘pain’.

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