Brian T. Swanson
© 2015 Nicholas Adriance
Background and Purpose: Lumbar Spinal Stenosis (LSS) is a clinical syndrome involving a narrowing of the space for the neural and vascular structures to pass. The purpose of this case report describes physical therapy management of a patient with chronic low back due to lumbar spinal stenosis with associated lumbar radiculopathy, status post carotid aneurysm. Case Description: The Patient was a 60-year-old female with a 20-year history of intermittent back pain and works as a crossing guard. The patient had radiographic evidence of multi level lumbar disc disease with central stenosis and foraminal narrowing most pronounced at L4-L5 and disc protrusion impinging on both the L4 and L5 nerve roots. The patient also has a complex medical background, including right carotid artery aneurysm with coils, depression, and had failed previous physical therapy and chiropractic interventions. A comprehensive therapy regimen including therapeutic strengthening/stretching exercises, manual therapy techniques with neuromuscular reeducation, and education regarding home exercise program and avoidance of provocative positions was utilized. Outcomes: Oswestry Low Back Pain Questionnaire, Lower Extremity Functional Scale, pain rating, strength, and range of motion improved 30 days after starting treatment. These improvements continued through a reassessment at 90 days. Discussion: The use of a well thought out comprehensive rehabilitation program consisting of therapeutic exercise, manual therapy, and consistent patient education may lead to a reduction in pain and improvements in activity tolerance. Due to her history of the right carotid artery aneurysm, care was taken when prescribing therapeutic strengthening exercises. Increased blood pressure associated with exercise and performing a Valsalva maneuver increases the risk of rupturing the repair. Further research is warranted to determine the most effective therapeutic protocol for patients with lumbar spinal stenosis.
Adriance, Nicholas, "Management Of A Patient Lumbar Spinal Stenosis and Carotid Aneurysm Using Therapeutic Exercise, Education, And Manual Therapy: A Case Report" (2015). Case Report Papers. 49.