Clinical Presentation of a Patient with Thoracic Myelopathy at a Chiropractic Clinic
SOURCE: J Chiropractic Medicine 2012 (Sep); 11 (2): 115–120
Charles W. Gay, Mark D. Bishop, and Jacqueline L. Beres
Graduate Research Assistant,
Rehabilitation Science Doctoral Program,
University of Florida, Gainesville, FL.
INTRODUCTION: The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic.
CASE REPORT/METHODS: After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult.
RESULTS: Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement.
CONCLUSION: It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment.
KEYWORDS: Spinal stenosis; Thoracic vertebrae
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Introduction
Narrowing (stenosis) of the spinal canal may result in myelopathy anywhere along the spinal axis where the spinal cord is present. A common cause of acquired stenosis resulting in myelopathy is degenerative changes (spondylosis). [1] These pathological changes are the same in the thoracic spine as those changes found in the lumbar and cervical regions and increase with age, [2] yet the frequency of myelopathy as a result of these changes is less in the thoracic spine than in the cervical spine. [1, 3, 4] These opinions are based on clinical observations, small surgical cohorts, and case reports and not on large population studies. Consequently, much is still unknown about the point prevalence, morbidity, and financial and social costs of the insidious development of stenotic myelopathy due to thoracic spondylosis. In addition, the clinical presentation of thoracic spondylotic myelopathy presenting to nonsurgical clinics is not widely described. Unlike some other causes of thoracic myelopathy that may present acutely, degenerative spondylotic myelopathy progresses insidiously over a period of time, leading to varying clinical presentations. [1, 4, 5] Thoracic myelopathy is often a vague manifestation of a mixture of signs and symptoms including sensorimotor dysfunction in the trunk and/or lower extremities, diffuse and/or well-localized pain in the thoracic or lumbar regions, radiculopathy, and possible urinary disturbances. [1, 3, 4]
Unlike cervical myelopathy, where clinical presentations have been previously described in the chiropractic literature, no such chiropractic case reports exist for thoracic myelopathy. Therefore, the purpose of this case report is to describe a clinical presentation, examination findings, and management decisions for a patient with thoracic myelopathy.
Case Report
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Very interesting article!
Dr. Jason Cheatle