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Chiropractic Care of a Female Veteran After Cervical Total Disk Replacement: A Case Report

By Frank M. Painter|May 7, 2023|Chiropractic Care, Chronic Neck Pain, Radiculopathy, Veterans|

Chiropractic Care of a Female Veteran After Cervical Total Disk Replacement: A Case Report

SOURCE: J Chiropractic Medicine 2022 (Mar); 21 (1): 60–65

OPEN ACCESS

Michael Mortenson DC, Anna Montgomery MPH, Glenn Buttermann MD

Whole Health Department,
Fargo VA Healthcare System,
Fargo, North Dakota.

Objective: The purpose of this case study is to describe chiropractic care of the cervical spine for a patient who previously underwent cervical total disk replacement (CTDR) of the C5–6 and C6–7 disks.

Clinical features: A 42–year-old female veteran of the U.S. Army presented to a Veterans Affairs chiropractic clinic with chronic cervical pain and radiculopathy. She had previously undergone CTDR surgery of the C5–6 disk 9 years earlier, but the pain had become severe and radicular symptoms had returned in the upper left extremity. Imaging taken before the chiropractic referral demonstrated significant joint space narrowing and disk herniation of the C6–7 disk with protrusion to the left side.

Intervention and outcome: The patient received spinal manipulative therapy, trigger-point therapy, and manual traction to the cervical spine. However, these treatments were not effective in reducing her cervical pain and radiculopathy. She then opted for CTDR of the C6–7 disk. After surgery, the patient reported that radicular symptoms were mostly relieved and cervical pain had decreased by 50%. After 6 additional spinal manipulative therapy treatments, she reported having no neurologic symptoms and that her pain had decreased more than 70% from presurgery levels.

Conclusion: This case report is the first reported example of chiropractic care after cervical total disk replacement (CTDR) within an integrated health care environment. The patient’s cervical pain and radiculopathy improved with CTDR along with postsurgical chiropractic care.

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CHIROPRACTIC CARE FOR VETERANS Section

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Observed Patterns of Cervical Radiculopathy

By Frank M. Painter|July 1, 2019|Radiculopathy|

Observed Patterns of Cervical Radiculopathy: How Often Do They Differ From a Standard, “Netter Diagram” Distribution?

The Chiro.Org Blog

SOURCE: Spine J. 2019 (Jul); 19 (7): 1137–1142

Steven J. McAnany MD , John M. Rhee MD , Evan O. Baird MD , Weilong Shi MD , Jeffrey Konopka MD , Thomas M. Neustein MD , Rafael Arceo MD

Department of Orthopedic Surgery,
Hospital for Special Surgery,
535 East 70th St,
New York, NY 10021, USA.

BACKGROUND CONTEXT: Traditionally, cervical radiculopathy is thought to present with symptoms and signs in a standard, textbook, reproducible pattern as seen in a “Netter diagram.” To date, no study has directly examined cervical radicular patterns attributable to single level pathology in patients undergoing ACDF.

PURPOSE: The purpose of this study is to examine cervical radiculopathy patterns in a surgical population and determine how often patients present with the standard textbook (ie, Netter diagram) versus nonstandard patterns.

STUDY DESIGN/SETTING: A retrospective study.

PATIENT SAMPLE: Patients who had single-level radiculopathy with at least 75% improvement of preoperative symptoms following ACDF were included.

OUTCOME MEASURES: Epidemiologic variables were collected including age, sex, weight, body mass index, laterality of symptoms, duration of symptoms prior to operative intervention, and the presence of diabetes mellitus. The observed pattern of radiculopathy at presentation, including associated neck, shoulder, upper arm, forearm, and hand pain and/or numbness, was determined from chart review and patient-derived pain diagrams.

METHODS: We identified all patients with single level cervical radiculopathy operated on between March 2011 and March 2016 by six surgeons. The observed pattern of radiculopathy was compared to a standard textbook pattern of radiculopathy that strictly adheres to a dermatomal map Fisher exact test was used to analyze categorical data and Student t test was used for continuous variables.

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Does Cervical Spine Manipulation Reduce Pain in People with Degenerative Cervical Radiculopathy? A Systematic Review of the Evidence, and a Meta-analysis

By Frank M. Painter|November 16, 2016|Radiculopathy|

Does Cervical Spine Manipulation Reduce Pain in People with Degenerative Cervical Radiculopathy? A Systematic Review of the Evidence, and a Meta-analysis

The Chiro.Org Blog

SOURCE: Clin Rehabil. 2016 (Feb); 30 (2): 145-155

Liguo Zhu, Xu Wei and Shangquan Wang

Department of Spine,
Wangjing Hospital,
Beijing, People’s Republic of China.

OBJECTIVE: To access the effectiveness and safety of cervical spine manipulation for cervical radiculopathy.

DATA SOURCES: PubMed, the Cochrane Central Registry of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang data, the website of Chinese clinical trial registry and international clinical trial registry by US National Institutes of Health.

REVIEW METHODS: Randomized controlled trials that investigated the effects of cervical manipulation compared with no treatment, placebo or conventional therapies on pain measurement in patients with degenerative cervical radiculopathy were searched. Two authors independently evaluated the quality of the trials according to the risk of bias assessment provided by the PEDro (physiotherapy evidence database) scale. RevMan V.5.2.0 software was employed for data analysis. The GRADE approach was used to evaluate the overall quality of the evidence.

RESULTS: Three trials with 502 participants were included. Meta-analysis suggested that cervical spine manipulation (mean difference 1.28, 95% confidence interval 0.80 to 1.75; P < 0.00001; heterogeneity: Chi² = 8.57, P = 0.01, I² = 77%) improving visual analogue scale for pain showed superior immediate effects compared with cervical computer traction. The overall strength of evidence was judged to be moderate quality. One out of three trials reported the adverse events and none with a small sample size.

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New Chiropractic and Radicular Pain Study

By Frank M. Painter|August 31, 2013|Chiropractic Care, Disc Injury, Radiculopathy|

New Chiropractic and Radicular Pain Study

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2013 (Aug 12)

Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up

Cynthia K. Peterson, RN, DC, M.Med.Ed, Christof Schmid, DC,
Serafin Leemann, DC, Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Department of Chiropractic Medicine,
Faculty of Medicine,
Orthopedic University Hospital Balgrist,
University of Zürich,
Zürich, Switzerland.
xraydcpeterson@yahoo.ca

This newly published prospective cohort study with 3-Month follow-up reports on the outcomes of 50 patients with MRI-confirmed cervical disc herniation who were also experiencing radiculopathy. Some of them were acute cases, but many of them also happened to be chronic pain patients.

A short, 3 month trial of chiropractic care led to significant improvements in all those individuals, and this improvement was sustained 3 months after care ceased.

OBJECTIVE: The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

METHODS: Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding “better” or “much better” on the patient’s global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

RESULTS: Fifty patients were included. At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.

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Chronic Neck Pain and Chiropractic Page

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Clinical Disorders and the Sensory System

By Frank M. Painter|April 11, 2013|Chiropractic Education, Diagnosis, Education, Evaluation & Management, General Health, Health Promotion, Neurology, Orthopedic Tests, Radiculopathy, Spinal Manipulation|

Clinical Disorders and the Sensory System

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 4 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 8: Clinical Disorders and the Sensory System

This chapter describes those sensory mechanisms, joint signals, and abnormal sensations (eg, pain, thermal abnormalities) that have particular significance within clinical diagnosis. The basis and differentiation of pain are described, as are the related subjects of trigger points and paresthesia. The chapter concludes with a description of the neurologic basis for the evaluation of the sensory system and the sensory fibers of the cranial nerves.

THE ANALYSIS OF PAIN
IN THE CLINICAL SETTING

Although all pain does not have organic causes, there is no such thing as “imagined” pain. Pain that can be purely isolated as a structural, functional, or an emotional effect is rare. More likely, all three are superimposed upon and interlaced with each other in various degrees of status. This is also true for neural, vascular, lymphatic, and hormonal mechanisms.

Common Causes of Pain and Paresthesia

The common causes of pain and paresthesia are:

(1) obvious direct trauma or injury;

(2) reflex origins in musculoskeletal lesions, which deep pressure often exaggerates, such as trigger areas;

(3) peripheral nerve injury (eg, causalgia), which results in an intense burning superficial pain;

(4) the presence of nerve inflammations and degeneration of the peripheral or CNS, which frequently cause other changes indicative of such lesions; (more…)

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Predictors of Outcome in Neck Pain Patients

By Frank M. Painter|August 25, 2012|Chiropractic Care, Chronic Pain, Neck Pain, Radiculopathy, Spinal Manipulation|

Predictors of Outcome in Neck Pain Patients Undergoing Chiropractic Care: Comparison of Acute and Chronic Patients

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Aug 24); 20 (1): 27

Cynthia K Peterson, Jennifer Bolton, B. Kim Humphreys

University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland

Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment.

Methods Acute (< 4 weeks) (n = 274) and chronic (> 3 months) (n = 255) neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQ) at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement.

Results Baseline mean neck pain and total disability scores were significantly (p < 0.001and p < 0.008 respectively) higher in acute patients. Both groups reported significant improvement at all data collection time points, but was significantly larger for acute patients. The PGIC score at 1 week (OR = 3.35, 95% CI = 1.13-9.92) and the baseline to 1 month BQ total change score (OR = 1.07, 95% CI = 1.03-1.11) were identified as independent predictors of improvement at 3 months for acute patients. Chronic patients who reported improvement on the PGIC at 1 month were more likely to be improved at 3 months (OR = 6.04, 95% CI = 2.76-13.69). The presence of cervical radiculopathy or dizziness was not predictive of a negative outcome in these patients.

CONCLUSIONS: The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

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Chronic Neck Pain and Chiropractic Page and the

A Clinical Model for the Diagnosis and Management Page

From the FULL TEXT Article:

Background

Patients suffering from neck pain are second only to low back pain patients in terms of the frequency of presentation for chiropractic treatment [1-4]. For many of these patients the precise diagnosis is difficult to ascertain and thus becomes labeled ‘non-specific’ neck pain or neck pain from mechanical dysfunction [1,3-5]. Research evidence has yet to determine with clarity whether spinal manipulative therapy (SMT) or mobilization of the neck is the superior treatment for these patients [1-9] although it appears that both of these treatments have better outcomes when combined with exercise [5,10]. (more…)

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