Chiropractic management of mechanical low back pain
secondary to multiple-level lumbar spondylolysis with
spondylolisthesis in a United States Marine Corps
veteran: a case report
Andrew S. Dunn DC, MEd, MSa,b,⁎, Shayne Baylisc, Danielle Ryanc
aStaff Chiropractor, VA of Western New York, Buffalo, NY 14215
bAdjunct Assistant Professor, New York Chiropractic College, Buffalo, NY 14215
cStudent, New York Chiropractic College, Buffalo, NY 14215
Received 19 February 2009; received in revised form 9 April 2009; accepted 16 April 2009
Key indexing terms:
Objective: This case report describes the evaluation and conservative management of
mechanical low back pain secondary to multiple-level lumbar spondylolysis with
spondylolisthesis in a United States Marine Corps veteran within a Veterans Affairs Medical
Center chiropractic clinic.
Clinical Features: The 43-year–old patient had a 20-year history of mechanical back pain
secondary to an injury sustained during active military duty. He had intermittent radiation of
numbness and tingling involving the right lower extremity distal to the knee. Radiographs
of the lumbosacral region demonstrated a grade I spondylolisthesis of L3 in relation to L4
and a grade II spondylolisthesis of L4 in relation to L5 secondary to bilateral pars
interarticularis defects. There was marked narrowing of the L4-5 disk space with associated
Intervention and Outcome: A course of conservative management consisting of 10
treatments including lumbar flexion/distraction and activity modification was provided over
an 8-week period. Despite the long-standing nature of the complaint and underlying
multiple-level lumbar spondylolysis with spondylolisthesis, there was a 25% reduction in
low back pain severity on the numeric rating scale and a 22% reduction in perceived
disability related to low back pain on the Revised Oswestry Disability Questionnaire.
Conclusions: Conservative management is considered to be the standard of care for
spondylolysis and should be explored in its various forms for symptomatic low back pain
patients who present without neurologic deficits and with spondylolisthesis below grade III.
The response to treatment for the veteran patient in this case suggests that lumbar flexion/
⁎Corresponding author. 3495 Bailey Ave, Buffalo, NY 14215, USA. Tel.: +1 716 807 8168; fax: +1 716 862 7248.
E-mail address: email@example.com (A. S. Dunn).
1556-3707/$ – see front matter © 2009 National University of Health Sciences.
Journal of Chiropractic Medicine (2009) 8, 125–130
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