Left L5-S1 Subarticular Herniation with Corresponding Lateral Recess Compromise – Moderate to Severe Left S1 Radiculipathy – Complicated by Degenerative Changes of Apophyseal Articulations [DPPP-SAA Treatment Protocol (Pre-Treatment and Post-Treatment Case Report-25)]

This patient is a 36 years old white male who had initially referred to this office complaining of pain and discomfort in the left lower leg and left knee of insidious onset, which eventually extended to the left gluteal region with paresthesia and later anesthesia of the bottom of the left foot. Patient indicated having developed difficulty walking, and significant pain during sitting within one week of initiation of his symptoms.

[Case Report-25 [Pre-Treatment MRI Study (Plate 2/6)]

This patient had been using analgesic medication including multiple steroid injections for the past 3 weeks in addition to complete rest for the past 10 days, which had resulted in temporary improvement. Following follow up visit with a neurosurgeon and considering patient’s neurological, and MR study findings, he was finally advised to under go surgical intervention. Upon examination in my office I also had a similar recommendation, considering the extend of the L5-S1 extrusion and of course the neurological presentation. However, patient was very concerned bout the long term impact of a surgical intervention, as it may have affected his professional career. He insisted having a medical history of a low back surgery can be constructed as a risk factor for his professional advancement , and he was determined to avoid it as much as possible.

[Case Report-25 [Pre-Treatment MRI Study (Plate 3/6)]

Consequently and after ordering an EMG/NCV to rule out any immediate neurological deficit, and having fully explaining the risk factors involved, patient was admitted for DPPP-SAA procedure. As it is the general procedure in these cases, decision regarding continuation of treatment is made following first three treatment sessions.