Narrative
This is a case of a 33 years-old white female who had referred to my office with the chief complaint of an exacerbated chronic lower back pain, and a recent addition of left leg pain. She reported history of lower back pain with variable intensity in the past, however; it was following an extraneous exercise program, that she first experienced increasing radicular pain involving the left lower extremity. Despite the use of medications including anti-inflammatory and analgesics for more than four weeks, in addition to 7 days of complete rest, physiotherapy, including laser, message, and use of lumbo-sacral support, etc., there was little improvement in the radicular symptom.
MRI, and plain film studies obtained, did reveal a large L5-S1 central sub-ligamentous extrusion extending into the left sub-articular space (Red Arrows), correlating with the clinical presentation. Presence of a transitional segment (Cyan Arrows), structural retro-listhesis of L5, further complicated with degenerative retro-discopathy of L4-5, and L3-4, associated with posterior shift of CG were also noted. [CR -20 (Plates: 1-3/6]
CR20_PrTx_AP Er 
CR20_PrTx_Lat Er
CR20_PrTxSagT2
This patient was also planing her first pregnancy, and as such, she was concerned about any long term side effects of a more aggressive treatment procedures.
CR20_PrTxSagT2
Initial examination in this patient had revealed; reduced Lumbo-Sacral ROM particularly in flexion, with marked deviation after 25 degrees of forward flexion, in addition to limitations in lateral bending. Left SLR was positive at 35 degrees, with negative CSLR. Patient was able to perform H/T walk adequately, DTR was intact, muscle strength 5/5 despite the radiculitis. Patient further reported having had difficulty standing following any extended sitting period, with even further exacerbation during extended standing, as can be expected with this type of IVD pathology.
CR20_PrTxMyelAP
She was subsequently admitted for initial phase (three sessions) of the DPPP-SAA treatment protocol with a guarded prognosis. Patient’s response to treatment was evaluated following the third session, with a meaningful reduction in left radicular pain (SLR 45 degrees). In fact, her radicular pain was significantly reduced within the first few sessions, and she continued to improve during the total of thirteen treatment sessions within a 21-day period.
