939 - Osteopathic Manipulative Medicine for Median Arcuate Ligament Syndrome Secondary to Congenital Hemivertebra-Scoliosis: A Case Report

79-year-old female reported a lifelong history of severe scoliosis, chronic low back pain, and progressive functional decline, experiencing deep, aching left-sided lumbar pain. The patient also exhibited post-prandial left upper quadrant pain, early satiety, and other gastrointestinal (GI) symptoms not explained by endoscopy or other GI diagnostics. Physical examination revealed severe lumbar levoscoliosis with marked paraspinal hypertonicity and tenderness. Imaging confirmed a sharp lumbar curve consistent with an L1 congenital wedge/hemivertebra. CT with and without contrast of abdomen pelvis showed a possible cause for median arcuate ligament syndrome (MALS) further defined as celiac artery compression by the medial arcuate ligament of the diaphragm, in this case due to structural changes from hemivertebra. The intervention that provided the most relief for her symptoms was osteopathic manipulative medicine.  

Discussions:

Osteopathic manipulative medicine (OMM), an evidence-based, non-pharmacological approach, was employed using techniques such as myofascial release, balanced ligamentous tension, soft tissue and muscle energy. OMM is often an underutilized adjunct for chronic pain management and functional optimization. It aims to address somatic dysfunctions, reduce myofascial strain, and enhance biomechanical efficiency. While OMM is not curative for fixed anatomical deformities, treatments resulted in decreased pain intensity and improved functional tolerance, including reduced GI symptoms and post-prandial pain. Furthermore, the diagnostic approach of osteopathy helped lead to the idea that her GI symptoms were biomechanical in origin. 

Conclusions:

This case highlights the intersection of severe musculoskeletal deformity and visceral dysfunction, where congenital hemivertebra-related scoliosis contributed to celiac artery compression and symptomatic MALS. It demonstrates how structural spinal pathology can manifest beyond the musculoskeletal system to cause significant gastrointestinal morbidity. OMM served as an adjunct to optimize function, reduce pain, and improve tolerance of daily activities.