Re-Stabilization of an Unstable Lumbosacral Segment in aPatient with Chronic back Pain: A Case Report

Background: Spinal instability is poorly understood. This case report describes the re-stabilization of an unstable vertebral motion segment in a patient with chronic low back pain. Case Presentation: A 50-year-old male presented at his local rheumatology service with chronic lumbo-pelvic pain. MRI revealed mid-lumbar disc degeneration with Modic 1 change at L3-4. An epidural steroid injection was given, followed by antibiotic therapy, but with no effect. A quantitative fluoroscopy (QF) assessment revealed instability at L5-S1 with hypomobility at the degenerate mid-lumbar levels. He received manipulation therapy to the mid-lumbar spine, plus activity modification to minimize lumbo-sacral stresses. This gave 70% improvement which was sustained over 5 years. Follow-up QF and MRI revealed reduction in lumbo-sacral instability, but no change in the L3-4-disc signal. Conclusion: This case report is the first to demonstrate restabilisation of an unstable vertebral motion segment.