Nucleus pulposus deformation following application of mechanical diagnosis and therapy: a single case report with magnetic resonance imaging

Abstract

Background: The McKenzie management strategy of mechanical diagnosis and therapy (MDT) is commonly used for the assessment and management of spinal problems. Within this system, 'derangement syndrome' is the most common classification, for which the conceptual model is an intra-discal displacement. However, the reduction of an intra-discal displacement by MDT has never been documented. The purpose of this study was to compare, using magnetic resonance imaging (MRI), the nucleus pulposus (NP) profiles before and after the use of this approach.Patient characteristics: The patient was a 34-year-old female with a long history of right sided low back and buttock pain classified with 'derangement syndrome'.Examination: T2-weighted images of the L4–5 disc at initial assessment were compared with that at final assessment 1 month later. Initially, the MRI showed a portion of the NP displaced right and posteriorly towards the side of pain, and an overall NP position in the coronal plane shifted to the left.Intervention: The patient was managed with a 1-month course of the McKenzie management strategy treatment.Outcomes: One month later, the displaced portion of the NP was no longer present and the left-shifted NP was centrally located.Discussion: These intervertebral disc changes coincided with centralization and abolition of symptoms. This case may support the conceptual model of MDT.