Left L5-S1 Subarticular Herniation with Corresponding Lateral Recess Compromise – Moderate to Severe Subacute Left S1 Radiculipathy – Complicated by Degenerative Changes of Apophyseal Articulations [DPPP-SAA Treatment Protocol (Pre-Treatment and Post-Treatment Case Report – 25)]
Lumbar disc herniations with subarticular involvement, particularly if it compromise the lateral recess, represents a clinical challenge. Choosing the proper treatment protocol in itself requires comprehensive neurological and bio-mechanical considerations and it should be a case by case decision making process.
Surgical intervention, in some cases, can lead to bio-mechanical limitations in the future, particularly in the younger age group who are generally more active. However, it is also important to keep in mind that in patients presenting with progressive neurological deficit, delay in surgical intervention may lead to irreversible neurological damage.
It is therefore important to further evaluate effectiveness of conservative treatment protocols in this and similar cases, as a safe treatment option which can be considered in appropriate cases.
This particular patient was deeply concerned with possible post complications of surgical intervention, consideration his professional career, which required heavy physical exertion.
This patient was diagnosed with Moderate to Severe Subacute Left S1 Radiculipathy due to Left L5-S1 Subarticular Herniation with Corresponding Lateral Recess Compromise – Complicated by Degenerative Changes of Apophyseal Articulations.
He was subsequently treated via Dynamic Patient Positioning Protocol – Sensory Assisted Application (DPPP-SAA) which is a Flexion / Extension based protocol, utilizing the S1 Locus Monitoring Instrument.
Patient response to this protocol was evaluated following the first three sessions of treatment with positive results, leading to continuation of the treatment protocol.
It is important to emphasize that pre-treatment and post- treatment MRI studies obtained, clearly defines discopathy related structural improvements, corresponding to patient’s clinical progress.
Conservative treatment protocols such as the DPPP-SAA protocol can represent a safe treatment option in similar cases with minimum short and long term side effects, keeping in mind that proper patient selection is the key to a positive treatment outcome.