Patient case (clinical description): A 57-year-old man comes to the emergency department due to constipation.  His last bowel movement was 2 days ago. He complains of spending about 30 minutes once attempting to defecate. He also has lower back pain.  There is no history of trauma. The pain is not relieved with over-the-counter pain medications.  His vital signs are within normal limits.  Examination shows low back pain that is worse with back flexion and raising of the legs; it radiates into his left leg.  Pinprick in the perianal area does not cause rapid contraction of the anal sphincter.  The rest of the neurologic examination is normal. He is suspected of Cauda Equina syndrome and referred to a spinal MRI.

Patient's own account: I'm a 57 year-old-man, and I had to go to the ER because I couldn't go defecate. My last trip to the toilet was 2 days ago, and I tried too many times, during 30 min, to get my poop to get out. I also have terrible lower back pain. The doctor did not notice any trauma. I tried to get the pain away using over-the-counter medications, but it simply did not work! Back in the ER my vitals were normal. My pain was even more intense with back flexion, and when I raised my legs, it radiated into my left leg. The doctor did an anus exam where he had to pinch it and it was not reacting! However the rest of my neurologic exam was normal. The doctor suspects a Cauda Equina syndrome and referred me to a spinal MRI.

Clinical trial: Chiropractic Dosage for Lumbar Stenosis

Eligibility criteria:
Inclusion Criteria:

          -  Males and females at least 50 years old with lumbar spinal stenosis

          -  Impingement of the cord and/or exiting nerve roots evidenced on spine imaging studies

          -  Symptomatic with current pain in the back and/or one or both of the legs.

          -  Symptoms must have been present for at least six months with an insidious onset

        Exclusion Criteria:

          -  Congenital stenosis or other spine deformities such as current spinal fractures,
             spinal infections, or tumors of the spine

          -  Prior lumbar spine surgery such as laminectomy, spinal fusion, or discectomy that
             lacks stability or occurred within the past 3 months.

          -  Currently pregnant or nursing

          -  Co-morbid conditions that may preclude a person from participating in active care
             (laying prone on a treatment table or completing exercises) and outcome measures
             (Treadmill Testing, completion of questionnaires), such as severe cardiopulmonary
             disorders (i.e.: severe coronary artery disease, recent myocardial infarction, or
             vascular claudication), neuromusculoskeletal disorders (i.e.: disabling hip or knee
             arthritis; trochanteric bursitis; piriformis syndrome; need for assisted ambulation),
             or brain disorders (i.e.: dementia or Alzheimer's Disease)

          -  Active conservative care such as physical therapy or chiropractic care for lumbar
             stenosis (excluding the use of oral medications or daily at-home exercises for general
             well-being)

          -  Cauda equina symptoms (i.e.: perianal numbness; loss of bowel and/or bladder control)

          -  Not fluent or literate in the English language. We will not be able to provide
             multiple translators within this pilot study

          -  Current or future litigation for low back or leg pain
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 50 Years old.


Eligibility (NLI label): Contradiction