Regression of Enlarged Lumbar Zygapophyseal Inclusions after Manipulative Therapy: A case report

We describe a case of low back pain (LBP) secondary to a facet syndrome, with a magnetic resonance image of enlarged zygapophyseal inclusions, which both regressed with manipulative therapy.The role of the lumbar zygapophyseal inclusion in the pain syndrome remains uncertain, because there are no studies on these inclusions in the lumbar facet syndrome. The explanation of the role of manual therapy is also uncertain (adjusting joint subluxations, restoring bony alignment, reducing nuclear protrusion, reducing meniscoid entrapment or extrapment, decompressing facet joints, etc).The diagnosis of classical facet syndrome LBP was made by history-taking and physical examination. The diagnosis of intra-articular enlargements was made by magnetic resonance imaging. The manipulative therapy consisted of manipulations in rotation with the spine placed in kyphosis. Before every manipulation session, spontaneous pain, pain with pressure on the zygapophyseal joint and the range of thoracic and lumbar spine motions were evaluated. After the fourth manipulation session, the patient's pain was alleviated and the enlarged zygapophyseal inclusions were no longer visible. The clinical improvement continued at the controls one and two months after the end of the manipulative therapy.This is the first report of facet syndrome LBP with a magnetic resonance image of enlarged zygapophyseal inclusions which both regressed with manipulative therapy. It is interesting to speculate on the possible mechanisms to explain this outcome, but further studies are needed.