Disclosures: Mengdong He, MHS: No financial relationships or conflicts of interest

Case Diagnosis: Chronic lower back pain due to anterolisthesis

Case Description or Program Description: A 48-year-old male with a history of myofascial pain and migraines presented with several years of chronic low back pain localized to the left sacroiliac joint and buttock with intermittent radiation down the left leg. The radiographic imaging of his lumbar spine demonstrated an anterolisthesis at L5-S1. The patient began a multi-modal treatment program including physical therapy, kinesiotherapy, aquatic therapy, chiropractor therapy, acupuncture, massage therapy, and activity modification. Due to limited symptom relief, the patient decided to seek prolotherapy (dextrose/lidocaine injections) in addition to his prior treatments.

Setting: Outpatient Physical Medicine & Rehabilitation clinic

Assessment/Results: Following the first prolotherapy injection, the patient reported approximately full pain relief compared to the pre-injection pain level (5-7/10). Over the next 3 years, the patient received 12 additional injections for recurrent pain at a lower level (3-4/10), endorsing further pain reduction with each visit. In addition, the patient reported his level of function has significantly improved.

Discussion (relevance): This case report is among the first to demonstrate a significant reduction of spondylolisthesis-induced lower back pain and improvement of function in the setting of adjunctive prolotherapy. While the mechanism of prolotherapy is not fully understood, prior research has found that dextrose can potentially promote a controlled inflammatory state that induces connective tissue growth and repair. This may have strengthened the ligaments surrounding the slipped vertebrae and contributed to the patient’s pain relief and restored function.

Conclusions: Prolotherapy could be a potential treatment for patients with lower back pain caused by spondylolisthesis and refractory to conventional therapies and improve their quality of life. Future experimental studies are needed to evaluate its efficacy in pain reduction and function improvement among patients with spondylolisthesis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prolotherapy-for-spondylolisthesis-induced-lower-back-pain-a-case-report/