Faculty Bibliography

This case report presents a 63-year-old male patient with chronic left foot drop. The etiology for his condition most likely involved lateral lumbar stenosis and/or sacroiliac joint dysfunction resulting in radiculopathy and subsequent symptoms. The patient was previously recommended a surgical approach for his condition. After an extensive osteopathic examination and application of a high-amplitude low-velocity technique, the patient reported a significant improvement in his pain and resolution of his foot drop. To the best of the author's knowledge, this is the first reported case of the use of osteopathic medicine in the successful treatment and management of left foot drop most likely secondary lumbar stenosis and/or sacroiliac joint dysfunction. The aim of this case report is to discuss the possible mechanisms by which the condition may have been resolved and the role that osteopathic treatment played in it.

The sacroiliac joint (SIJ) can cause pain after lumbosacral fusion. Diagnosis requires >75% relief after local anesthetic SIJ injection. This study is a retrospective review of patients with low back pain after lumbosacral fusion who had SIJ injections. Percentage and duration of pain relief were noted. Results are as follows: there were 34 patients; 8 fused at L5-S1, 14 fused at L4-S1, and 12 had multilevel fusions. Twenty had >75% relief within 45 minutes, and 11 had prolonged relief. Six had relief >20% but <75%, and one had prolonged relief. Eight never improved. Eight had posterior iliac crest bone harvested, and there was no correlation between donor side and pain side. In 34 patients with low back pain after lumbosacral fusion, SIJ was the cause of pain in 32% and possibly the cause in 29%. This is the first detailed description of this problem.