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Chronic low back pain: block vertebra Darshpreet Kaur, 1 Nidhi Billore, 2 Gunjan Kumar, 3 Puneet Aggarwal 4 1 Department of Physiotherapy, Bihar Neurodiagnostic Centre, Patna, Bihar, India 2 RV College of Physiotherapy, Bangalore, Karnataka, India 3 Department of Internal Medicine, Dr Ram Manohar Lohia Hospital, New Delhi, India 4 Department of Internal Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India Correspondence to Dr Puneet Aggarwal, [email protected] To cite: Kaur D, Billore N, Kumar G, et al. BMJ Case Rep Published online: [ please include Day Month Year] doi:10.1136/bcr-2013- 009176 DESCRIPTION A 52-year-old woman came to our rehabilitation department with a history of chronic low back pain radiating to both the legs. Her history was uneventful except for well-controlled depression and occasional pain killers for last 4 years. Examination revealed considerable postural asymmetry with right hip higher than left and right shoulder lower than left, paraspinal muscle fullness in the lumbar region, decreased lumbar lordosis, tenderness in L2–L5 lumbar vertebrae and in gluteal region. There was sig- nificant pain on lateral bending and spinal rotation which increased while coming from flexion to hyper- extension. Manual muscle testing revealed weakness in abdominals, hip flexors (3/5) and quadriceps (4/5). Straight leg raising test was positive bilaterally and so was the prone lumbar instability test. X-Ray showed Grade 1 anterolisthesis ( figure 1) of L3 over L4, block vertebrae of L4 and L5 and degenerative changes are predominantly involving L5 and S1 vertebrae. Considering it to be a case of block vertebra with chronic low back pain with radiculopathy, she was educated about her problem and various pain relieving positions. Guidance was given on proper posture maintenance and body mechanics with regular strengthening exercises. Modalities like moist heat and cryotherapy were recommended to relax muscles and reduce pain. The presence of lumbar block vertebrae is less common, 1 but if present, it results in premature degenerative changes owing to altered biomechanics. 2 Thus early diagnosis of these anomalies and thorough workup will be helpful in establishing primary diagnosis and documenting long-term changes owing to these conditions. Also timely education of the patient to change life style can help keep various complications at bay. Learning points ▸ Congenital blocked lumbar vertebra is a less common developmental disorder. ▸ Thorough workup of the patient is important to pin point affected areas. ▸ Patient education and life style modifications play a vital role. Figure 1 Grade 1 anterolisthesis of L3 over L4, block vertebrae of L4 and L5 and degenerative changes are predominantly involving L5 and S1 vertebrae. Kaur D, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-009176 1 Images in …
Transcript of Images in - BMJ Case Reportscasereports.bmj.com/content/2013/bcr-2013-009176.full.pdf · Medicine,...
Chronic low back pain: block vertebraDarshpreet Kaur,1 Nidhi Billore,2 Gunjan Kumar,3 Puneet Aggarwal4
1Department of Physiotherapy,Bihar Neurodiagnostic Centre,Patna, Bihar, India2RV College of Physiotherapy,Bangalore, Karnataka, India3Department of InternalMedicine, Dr Ram ManoharLohia Hospital, New Delhi,India4Department of InternalMedicine, PGIMER & Dr RamManohar Lohia Hospital, NewDelhi, India
Correspondence toDr Puneet Aggarwal,[email protected]
To cite: Kaur D, Billore N,Kumar G, et al. BMJ CaseRep Published online:[please include Day MonthYear] doi:10.1136/bcr-2013-009176
DESCRIPTIONA 52-year-old woman came to our rehabilitationdepartment with a history of chronic low back painradiating to both the legs. Her history was uneventfulexcept for well-controlled depression and occasionalpain killers for last 4 years. Examination revealedconsiderable postural asymmetry with right hiphigher than left and right shoulder lower than left,paraspinal muscle fullness in the lumbar region,decreased lumbar lordosis, tenderness in L2–L5lumbar vertebrae and in gluteal region. There was sig-nificant pain on lateral bending and spinal rotationwhich increased while coming from flexion to hyper-extension. Manual muscle testing revealed weaknessin abdominals, hip flexors (3/5) and quadriceps (4/5).Straight leg raising test was positive bilaterally and sowas the prone lumbar instability test.X-Ray showed Grade 1 anterolisthesis (figure 1)
of L3 over L4, block vertebrae of L4 and L5 anddegenerative changes are predominantly involvingL5 and S1 vertebrae.Considering it to be a case of block vertebra with
chronic low back pain with radiculopathy, she waseducated about her problem and various pain
relieving positions. Guidance was given on properposture maintenance and body mechanics withregular strengthening exercises. Modalities like moistheat and cryotherapy were recommended to relaxmuscles and reduce pain. The presence of lumbarblock vertebrae is less common,1 but if present, itresults in premature degenerative changes owing toaltered biomechanics.2 Thus early diagnosis of theseanomalies and thorough workup will be helpful inestablishing primary diagnosis and documentinglong-term changes owing to these conditions. Alsotimely education of the patient to change life stylecan help keep various complications at bay.
Learning points
▸ Congenital blocked lumbar vertebra is a lesscommon developmental disorder.
▸ Thorough workup of the patient is importantto pin point affected areas.
▸ Patient education and life style modificationsplay a vital role.
Figure 1 Grade 1 anterolisthesis of L3 over L4, block vertebrae of L4 and L5 and degenerative changes arepredominantly involving L5 and S1 vertebrae.
Kaur D, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-009176 1
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Contributors DK supervised the overall patient management, NB helped incarrying out patient assessment, and PA and GK helped in differential diagnosis ofthe patient.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES1 Kumar R, Guinto FC, Madewell JE, et al. The vertebral body: radiographic
configurations in various congenital and acquired disorders. Radiographics1988;8:455–85.
2 Guebert GM, Rowe LJ, Yochum TR, et al. Congenital anomalies and normal skeletalvariants. In: Yochum TR, LJ Rowe, Eds. Essentials of skeletal radiology. Baltimore:Lippincott Williams & Wilkins, 2005:278–87.
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2 Kaur D, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-009176
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