Sub-acute Exacerbation of Moderate-Severe Right S1 Radiculopathy – Right Paracentral L5-S1 Herniation Causing Lateral Recess Compromise – Complicated by L5 Structural Retrolisthesis, Modic Type II Changes of the Corresponding Segment (Pre-Treatment and Post-Treatment Clinical Case Report – 30)


Lumbar lateral recess neural compromise are challenging cases to treat conservatively. Particularly when complicated by structural retrolisthesis and degenerative changes as seen in this case. 

Recent moderate – severe exacerbation of a chronic radiculopathy in this patient, was not responsive to rest, medication, injections, nor physiotherapy. 

As surgical intervention was contemplated, a few sessions of specific closed decompression protocol (DPPP-SAA) were applied with acceptable results. 

Following completion of the initial phase of the treatment protocol, even though the structural IVD changes were limited in the initial follow-up MRI study, the patient had improved significantly and she was fully functional. 

Considering that this patient was not fully compliant with the recommendations, she did continue to remain fully functional despite a few mild exacerbations.

A second follow up MRI study was obtained a few months later which did indicate significant structural improvement, consistent with the patient’s clinical presentation. 

Specific bio-mechanical considerations in the treatment protocol, significance of IVD structural pathology chronicity and morphology as conveyed prognosis were also discussed.

Follow up MRI studies were also evaluated, confirming IVD structural improvement, consistent with patient clinical presentation.

H. Sabbagh D.C.