CT demonstration of disk regression after conservative therapy.

A 25-year-old man had several episodes of low back pain over a 3-year period. The initial episodes were described as simple backaches, unassociated with radicular pain, and were relieved by bed rest and aspirin . One year later, the patient sought chiropractic therapy on two occasions for recurrent backache. He failed to obtain relief and, while under treatment, began to experience radiating pain to the left buttock and posterior aspect of the left thigh . These pains were exacerbated by walking , coughing , and straining. They were relieved by lying down with the back in flexion and by squatting. Physical examination on admission revealed weakness of the extensor hallucis longus and softness of the calf musculature on the left. Straight leg raising , sitting straight leg, bowstring signs, and Deyerle sign were all positive on the left. His range of motion showed decreased flexion, and he had listing to the left which increased on forward bend. An L4L5 herniated disk was suspected clinically and confirmed by CT (figs . 1 A and 18). The patient was managed conservatively , and in 7 weeks he was virtually asymptomatic except for mild backache, primarily on the right side. A CT scan obtained after conservative therapy revealed dramatic reduction of the disk herniation (figs. 1 C and 1 D).