Large abdominal aortic aneurysm presented with concomitant acute lumbar disc herniation - a case report

Abstract

The purpose of this case report was to describe chiropractic management of acute lumbar disc herniation in a patient with a large abdominal aortic aneurysm. A 72-year-old male patient presented with low back pain and right lower leg numbness for 12 months. A review of full-spine X-ray and lumbar MRI revealed moderate spondylosis at L2-5, moderate lumbar scoliosis, and a 7.15 cm abdominal aortic aneurysm (AAA). Given the minimum 2-weeks of referral waiting time to receive treatment for AAA, the patient received chiropractic treatment with a hybrid rehabilitation to address the disc herniation causing severe physical disability. Through the treatments, the patient's pain was significantly alleviated with careful consideration of potential risk factors associated with AAA. In addition, the acute disc herniation was successfully managed by a series of chiropractic treatments before and after the operation for AAA. This case supports that low back pain in patients with AAA can be managed by manual therapy, in contrast to a widespread belief that manual therapy is contraindicated in AAA. More case reports of AAA patients with low back pain are warranted to assess the effectiveness and safety of manual therapy along with surgical treatment for AAA.

Keywords: AAA; AAA – Abdominal aortic aneurysm; CT – Computed tomography; MRI – Magnetic resonance image; NSAIDs – Nonsteroidal anti-inflammatory drugs; abdominal aortic aneurysms; chiropractic therapy; patient-centric.

Figure 1

Lateral view identified the presence of a significant calcified aorta from the L2-L5 region.

Figure 2

Magnetic resonance (MR) image revealed dilatation of abdominal aorta (red arrows) and marginal osteophyte formation of the lumbar vertebrae and posterior protrusion at the L3/L4 and L4/L5 levels pinching the spinal nerve extending from the spinal cord and cauda equina (red arrow).

Figure 3

Computed tomography abdominal aortogram measured a 7.15 cm × 5.67 cm × 5.46 cm diameter abdominal aortic aneurysm.