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Bret White
Ralph Kruse
Kurt Olding


Synovial Cyst, Low Back Pain, Flexion-Distraction Therapy


Objective: To describe the chiropractic treatment of a patient with a chronic, symptomatic L4-L5 synovial cyst using the Cox® flexion-distraction manipulation.

Clinical Features: A 75-year-old retired postal worker had lower back pain radiating into his right buttock, of non-traumatic onset. The pain was present for 4-5 months and was rated as severe when standing or walking. Magnetic resonance imaging documented a large synovial cyst at L4-L5.

Intervention and Outcomes: Treatment consisted of Cox® flexion-distraction to the lumbar spine for a total of 6 treatments over approximately 3 weeks. The initial numerical pain rating scale (NPR) was 3-4 at rest and was rated as severe when standing or walking. The Oswestry Disability Index (ODI) was 48%. The final NPR was rated as 0 at rest, and the ODI was 36%. This represents a 25% improvement in the ODI and a 100% improvement in resting pain.

Conclusion: The Cox® flexion-distraction manipulation may be an effective conservative option for symptomatic lumbar synovial cysts. This becomes important in a patient who has several co-morbidities which make surgery a riskier option.


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