The Extrusion Experience: A Case Report on Successful Outcome of Severe Lumbar Disc Herniation with Conservative Management

Background: Lumbar disc herniation (LDH) is a common cause of low back pain and disability, especially when associated neurological impairments are present. Conservative management such as epidural steroid injections and physical therapy are common treatments of LDH, especially when surgery is not indicated. It has been reported in research to base clinical decisions regarding surgical versus non-surgical treatment of LDH on severity of symptoms. However, research is limited in demonstrating clinical outcomes of individuals with severe LDH when managed non-surgically. Purpose: The purpose of this case report is to highlight a successful outcome of a young adult male with severe lumbar disc herniation treated conservatively. Case Description: A 24-year-old male with a history of chronic low back pain and lumbar herniated discs presented direct-access to a private outpatient physical therapy facility with complaints of posterior right lower-extremity numbness, ankle weakness, and abnormal walking. Interestingly, the patient did not present with notable pain in his back or lower extremity. Interventions: 15 weeks of physical therapy intervention including manual therapy, core stabilization training, and functional pattern training. The patient also received a lumbar epidural steroid injection. Outcomes: At 15 weeks post-injury, the patient demonstrated significantly improved right-sided plantar-flexion strength, Achilles’ reflex, gait, and functional activity tolerance, but less-significantly improved altered sensation throughout his S1 dermatomal distribution. Discussion: Due to the patient’s improvement in symptoms, he was able to return to functional and recreational activities. This case highlights the multifactorial, individualized nature of treatment and clinical decision making on whether surgery is an appropriate step in a patient’s course of care and/or what specific physical therapy interventions should be prescribed to maximize healing and functional recovery.