Roni, a 68 year old female, presented to my office reporting severe low back pain traveling into the groin and the upper thighs on both sides. The first thing I noticed was that she got winded when she spoke to me. She had been under chiropractic care on and off for many years. My belief was that she was experiencing sciatica. One note on sciatica is that it is usually (but not always) on one side. When we took two x-rays of her lower back. There was moderate degeneration of the joint spaces of the low back, (what I like to call rust or decay). There were two other findings that were significant.

One of her low back vertebra was shifted forward (from a healed fracture called a spondyloltheis). This is not that uncommon. More importantly, her abdominal aorta was enlarged and had calcification. The aorta is the largest artery in the body and starts at the diaphragm and then splits to supply blood to each leg. Some calcification is common, and not considered to be alarming. The width of the aorta, however, must be measured, as this can be athe sign of a serious condition called an aneurysm. 

I kept her treatment that day very minimal and used light-force mobilization techniques. I discussed this with the other doctor in the office and consulted with a chiropractic radiologist. We measured the abdominal aorta diameter and it was 2.5 cm. It is normally 2.0 cm. 

After our group meeting, I called the patient to discuss having an ultrasound of the abdominal aorta. I explained that it was larger than average and that one of the symptoms can be low back pain. I explained that we needed to rule out symptoms related to an aneurysm. She had an upcoming ultrasound with a vein specialist for some of the vessels in her legs. I asked her to request an abdominal ultrasound as well. Later that day, I spoke to one of the nurse practitioners at the clinic and described our x-ray findings. An abdominal ultrasound was ordered.

Roni went in for the ultrasound. The good news was that she did not have an aneurysm but the abdominal aorta would have to be monitored. What they did find was hardening of both femoral arteries, which are branches of the aorta that supply the legs

The patient called me to talk about the results and felt relieved that there was no aneurysm but that they would continue to check periodically because of the plaguing in the femoral arteries. When she had a follow-up with her PCP, her doctor asked why I had taken an x-ray and why I recommended an abdominal aneurysm. Roni told her about our conversation, and explained that we had run the x-rays by a radiologist. Suddenly, this was okay. What she didn’t tell her PCP was that it was a chiropractic radiologist! Roni told me she was not happy that her doctor was questioning my decision to further look into this issue, as it could have been a dangerous situation. The doctor had focused rather on her spondylolethesis. I explained that we see these often, and they, too, have to be monitored in the case they unstable (it was not upon x-ray analysis). 

After four visits with me, Roni noticed that her mobility and activities of daily living had improved. Her pain was no longer in her back and had localized to her upper thighs. I continued to check her lower back and while her range of motion was somewhat limited, her orthopedic exam findings had improved.  With further discussion, Roni came to the conclusion that her biggest concern was her arteriosclerosis and felt her upper thigh pain was a symptom. 

She was grateful for the thoroughness of my initial examination and for the report of findings, which is when we go over the examination and  x-ray findings with our patients and make treatment recommendations. She stated that it made her more aware of what was going on inside of her body. When I left that office to join Performance Health Center, Roni continued her chiropractic care with a functional medicine practitioner. 

I was proud of Roni for being her own advocate. The take away….always listen to your body and don’t ignore symptoms!!!