Denne et al. Journal of Medical Case Reports 2011, 5:440 http://www.jmedicalcasereports.com/content/5/1/440 Page 2 of 4 Table 1 Data from our three patients with cystic fibrosis with lumbar disc herniation (LDH) Patient Age at case Age at no. presentation diagnosis of LDH (imaging) Localization of LDH Neurosurgical Positive Use of Use of Forced Vital operation family history opioids NSAIDs expiratory capacity of LDH volume (FEV1) (VC) 1 2 3 22 23 21 21 19 21 L4/L5 median, L5/S1 Yes median L5/S1 left mediolateral L4/L5 left paramedian; L5/S1 left paramedian No No Parent Parent No Yes No Yes Yes Yes Yes 3.98L (89.7%/ norm) 2.53L (61.1%/ norm) 0.99L (30.7%/ norm) 5.10L (92.6%/ norm) 4.48L (88.1%/ norm) 1.67L (45.6%/ norm) Total number of patients was 46; 24 of these patients were 18 years of age or older. Patient 3 died eight months after diagnosis of LDH. NSAID = non-steroidal anti-inflammatory drug. pain radiation. Our patient held his excessive physical training responsible for the motion-dependent pain, espe- cially on hip flexion. After a non-operative approach with physiotherapy at first, a decompression operation was then performed because of increasing pain (maximum 10/10 on visual analog scale, opioid dependent) approximately five months after LDH was diagnosed using NMR. For the first two days following the operation, our patient needed nasal oxygen of 1L per minute via prongs and our patient had lumbalgia for about three months after the operation. Intensive physiotherapy was performed post-operatively. No chest infection (pulmonary exacerbation) occurred in the recovery period. His bone density was not examined. Figure 1 and 2 show two representative NMR slides from patient 1 with LDH in lumbar vertebra 4/5 (L4/L5) and L5/sacral vertebra 1 (S1). Case 2 Patient 2 was a 23-year-old Caucasian man (delta F 508 homozygous, Pseudomonas positive) who first presented nine years before the date of the documented case to an ambulant orthopedist with acute back pain for three days. A lumbar X-ray was performed which showed hyperlordo- sis. His bone density was not examined. No special therapy was initiated. About five years before the date of his most recent presentation, our patient had an NMR scan; LDH was suspected as he presented with lumbalgia with left- sided pain radiation. After the diagnosis of a mediolateral LDH at L5/S1 was established, subsequent intermittent episodes of low back pain have been well treated by our patient with muscular training in a fitness center and NSAIDs. No control spinal imaging has been performed so far. His lung function did not change relevantly after the LDH diagnosis. Our patient suffers from allergic asthma (expiratory flow limitation in lung function) comorbidity and recurrent episodes of allergic broncho- pulmonary aspergillosis (ABPA), for which he currently needs prednisolone in doses of 5 to 10 mg/day. Bone frac- tures have not been diagnosed to date. Case 3 Patient 3 was a 21-year-old Caucasian woman with an end-stage obstructive and restrictive ventilation disorder (Table 1), who presented to our facility with severe lower back pain, left-sided ischialgia and paresis of the Figure 1 A sagittal T2-weighted MRI image of the lumbar spine showing a centrally located disk herniation at L4/L5 and to a lesser degree at L5/S1. Note the decreased signal of the L4/ L5 and L5/S1 disks, indicating decreased disk hydration.