Struck from behind: maintaining quality of life with chronic low back pain.

摘要

A 38-year-old woman was the driver of a stopped car that was struck from behind by another vehicle. She developed sudden flexion and extension of her back, but without head trauma or change in level of consciousness. On the evening of the accident, she presented to the emergency room with severe mid and low back pain, and right knee pain, but was discharged with pain medications. One week following the accident, the pain became increasingly severe. For the past 6 months, she has been unabletoworkand is on disability. Chiropractic treatment, trigger-point injections, epidural injections and physical therapy, nonsteroidal anti-inflammatory drugs, muscle relaxers, and hydrocodone provided no or minimal relief. An MRI of the thoracicspine revealed a sub-acute appearing left paracentral disc hemiation at T_(11)-T_(12), with effacement of the subarachnoid space, but without spinal-cord or nerve-root compression; an MRI of the lumbar spine revealed a disc bulge at L4-L5 without significant mass effect; and EMG and nerve-conduction studies of the lower extremities were normal.