title: Chiropractic high-velocity low-amplitude spinal manipulation in the treatment of a case of postsurgical chronic cauda equina syndrome.
abstract: OBJECTIVE
  To present an evidence-based case report on the use of chiropractic high-velocity low-amplitude spinal manipulation in the treatment a postsurgical, chronic cauda equina syndrome patient.
  
  
  METHODS
  A 35-year-old woman presented with complaints of midback pain, low-back pain, buttock pain, saddle anesthesia, and bladder and bowel incontinence, all of 6 months duration. The patient was 6 months post emergency surgery for acute cauda equina syndrome due to lumbar disc herniation. She had been released from neurosurgical care with the current symptoms considered to be residual and nonprogressive.
  
  
  RESULTS
  The patient was treated with high-velocity low-amplitude spinal manipulation and ancillary myofascial release. After 4 treatments, the patient reported full resolution of midback, low back, and buttock pain. The patient was seen another 4 times with no improvement in her neurologic symptoms. No adverse effects were noted.
  
  
  CONCLUSIONS
  This appears to be the first published case of chiropractic high-velocity low-amplitude spinal manipulation being used for a patient with chronic cauda equina syndrome. It seems that this type of spinal manipulation was safe and effective for reducing back pain and had no effect on neurologic deficits in this case.
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA. anthony.lisi@med.va.gov
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Lisi
authors.forename: Mukesh K
authors.initials: MK
authors.lastname: Bhardwaj
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D026882:Manipulation, Chiropractic / Q000379:methods*; D011128:Polyradiculopathy / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy*