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: A Comparative Study: Non-Surgical Spinal Decompression and Spinal Manipulative Therapy- Utilizing a Quantifiable Musculoskeletal Functional Assessment Risk Analysis Tool (MSDR®) in Patients With Chronic Low Back Pain

Eligibility criteria:
Inclusion Criteria:

          -  Must have Informed Consent Signed

          -  Lumbar Disc Herniations under 5mm without Sequestered Fragments

          -  Lumbar Disc Bulging

          -  Lumbar Degenerative Disc Disease (mild and moderate severity)

          -  Non-pregnant Females and Males suffering from Chronic Low Back Pain from 18 to 65
             years of age

          -  Segmental Dysfunction Secondary to Dyskinesia

          -  Unresolved Nerve Entrapment Syndrome

          -  Patients must be able to comply with study protocol

          -  Joint Fixation Syndrome

          -  Premenopausal Female Patients, excluding patients who have undergone a hysterectomy,
             oophorectomy, or tubal ligation, must have one of the following methods of
             contraception and must have a negative serum or urine b-HCG pregnancy test performed
             within 48 hours before initiating protocol specified treatment.

        Exclusion Criteria:

          -  Contraindications to Spinal Manipulative Therapy

          -  Lumbar Canal Stenosis resulting in significant neurological comprimise

          -  Any Spinal Cord Compression resulting in significant neurological comprimise

          -  Cauda Equina Syndrome

          -  Infection

          -  Osteomyelitis

             ->65 years of age

          -  History of Back or Neck Surgery

          -  Acute Arthritis

          -  Signs or Symptoms of Arterial Aneurysm

          -  History of Active Cancer with Bone Metastasis

          -  Widespread Staphyloccal and/or Strepococcal Infection

          -  Acute Gout

          -  Serious unstable medical illness such as cardiovascular, renal, respiratory,
             endocrine, gastrointestinal, or psychiatric.

          -  Unstable Spondylosis, Spondylolisthesis, or Spondylolysis

          -  Prior adverse experience with Spinal Manipulation Therapy

          -  Uncontrolled Diabetic Neuropathy

          -  Gonorreal Spinal Arthritis

          -  Tuberculosis to the Bone

          -  Maligancy with Metatasis to Bone

          -  Excessive Spinal Osteoporosis

          -  Osteomalacia

          -  Ankylosis

          -  Syphlitic Articular or Peri-Articular Lesions

          -  Active Low Back Injury Resulting from a Motor Vehicle Accident or Work Related Injury
No condition on gender to be admitted to the trial.
Accepts Healthy Volunteers
Subject must be at least 18 Years old.
Subject must be at most 65 Years

Eligibility (NLI label): Contradiction