Case 1

• 44 year old male truck driver
• Complaining of low back pain of long standing constant low grade daily pain with recent gradual worsening
• Worse with sitting and bending
• Better with heat
• Previous treatments: Stretch, over the counter meds (NSAIDS, Tylenol)
• Exam suggestive of diffuse low back pain, neurological exam intact, good range of motion
• 8 session of adjustments
• Patient’s pain improved both in intensity, frequency and the area of pain was significantly reduced
• Motion of the spine upon palpation normalized
• However, patient continued to have pain in a focal area left low back

Spines Structures

Back Pain

• Affects 2/3 of adults
• 2nd most common reason for physician visit
• Most common reason for work disability

Disk Degeneration

Athritis

Exam Under Fluoroscopy

• Patient underwent left sided L3/4 and L4/5 lumbar facet injections
• Per patient request the procedure was done with local anesthesia only

Lumbar Facet Joint Injections

Case 1 Details

• Immediate post op response 100% pain relief
• 2 weeks later patient still has no back pain but continues to get adjustments

Facet Joint Injection

Facet Joint Medial Branches

Lumbar Radiofrequency Neurotomy (Rhizotomy)

Medial Branch Block

Case 2 Details

• 34 year old male coming from ER with diagnosis of sciatica
• Complaining of severe 8/10 VAS Low back right buttock and leg pain
• Started 3 weeks prior after playing softball. He was then also involved in a MVA a week prior to visit, which worsened symptoms
• Did complete exam. Disc Suspected
• Gave patient choice of daily chiro visits or to see pain and begin chiro once severe pain has decreased.
• He chose pain.
• Normal neurological exam
• Positive straight leg raise test at 15 degrees on the right side.
• Started on NSAIDs, muscle relaxant and low dose narcotics
• Ordered MRI

• L3/4 Right paracentral disc protrusion/extrusion as well as annular tear
• L4/5 Central to right paracentral disc extrusion as well as annular tear​

New Approach: Ultra Minimally Invasive