Effective Management of McKenzie Derangement VI With Urge Urinary Incontinence Through Surgical Intervention and Customized Physiotherapy: A Case Report

Abstract

Urge incontinence, often linked to prolapsed intervertebral disc (PIVD) due to nerve compression, involves sudden, involuntary urine leakage. Management includes behavioral therapy, bladder training, and pelvic floor muscle training (PFMT) to strengthen pelvic muscles and regulate voiding, effectively reducing symptoms and improving quality of life. A 40-year-old female patient presented with chief complaints of lower back pain radiating down the right lower limb below the knee, accompanied by a right-sided listing. Based on the McKenzie classification, she was diagnosed with McKenzie derangement VI, characterized by unilateral/asymmetrical pain across the L4-L5 region, radiating pain below the knee, and the presence of deformity, specifically trunk deviation away from the painful side that is the right side. Additionally, she reported experiencing urge urinary incontinence. Following surgery, she experienced significant reductions in pain and urinary incontinence, improved posture, and an enhanced quality of life. Surgical decompression and spinal fixation effectively alleviated neural compression and instability at the L4-L5 and L5-S1 levels. At the same time, the phased physiotherapy approach facilitated recovery through pain management, neuromuscular re-education, and functional restoration. Preoperative assessments such as the modified Schober’s test, visual analogue scale (VAS), Revised Oswestry Disability Index (RODI), sciatica bothersome index, revised urinary incontinence scale (RUIS), and Michigan incontinence symptom index (MISI) were essential in guiding the rehabilitation process and measuring progress. The integration of these multidisciplinary interventions underscores the importance of a comprehensive treatment plan in achieving positive outcomes for PIVD, despite the potential for complications such as chronic pain and disability.