Dear sir,

I suggest to do manipulative therapy on his lower thoraxic to upper lumbar
spine (L2), because I gueese that his pain could come from
neuroischemic. So, we have to mobilise the tension point as well.

Good luck

Rungthip Puntumetakul
Thailand

On Mon, 10 May 1999, sood wrote:

> HELLO EVERYBODY!
>                                     Working  with back pain is strange ,sometimes a simple looking case is tied and sometimes a difficult case with migrating pain and paresthesia   responds and like a  magic and it is gone for good.
>                                     I invite my friends to send their expert opinion in following case:
> 
>              On one fine morning about a year back 25yrs old Policeman reported  at my office with severe back pain in L4/L5 area ,localized ,local tenderness on deep palpation was present,no refered pain or paresthesia     was present .At that time he gave no history of    trauma  or fever.However after repeated  questioning he agreed to have fallen from a tree during an commando operationmany years back.  upon   X-ray examination anterior compression fracture of L4 vertebra was seen
> I advised him LS corset ,rest ,NSAIDS,muscle relaxant,interferential therapy & Short wave Diathermy was added.After many months on physiotherapy & Chemotherapy and rest he only showed aggravation of pain   nothing seems to help.His blood investigations were within normal limit,but ESR was Raised Mtx weekly postiveSo far he was in extreme pain not drug even Opoids derivatives antidepressants seemed to help,than I put him on anti tuberculosis drugs
> five months back.Still he showed no improvement.Somwhere in between some doctor gave him Cortisone injection,he even weent to a quack for some manipulations(,as in India there are no qualified manual-therapist,) In sheer desperation he  even went to a tantaric i.e black magic to shun away any evil spirit.after going around everywhere he retained back to me meanwhile he continued ATT.He is unable to sit,walks with kyphosis.and pain is constant.He is not willing to undergo surgery.
> Then I ordered MRI;it shows
> 1.. Canal stenosis both bony and secondary type at L3,L4,L5 levels with sagital and lateral canal compromise.
>     2.. Postero-central disc protusion L4-5,L5-S1 Discs.
>     3.. Old Compression fracture L4.
>     4.. Nointraspinal mass or pre/para vertebral mass is seen
>     What conservative treatment if their is any could be attempted?
> Shall he continue ATT drugs.?
> waiting for your valued opnion.
>                                         Thanking you,
>                                                                             Dr.S.C.Sood
>                                                                                 Orthopaedic Surgeon
>                                                                                     E-mail [log in to unmask]
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