Chiropractic care of a patient with vertebral subluxations and unsuccessful surgery of the cervical spine

Resolution of cervical radiculopathy in a woman after chiropractic manipulation

OBJECTIVE

To describe a case regarding a woman with 2-level cervical disk herniation with radicular symptoms conservatively treated with chiropractic care including high-velocity, low-amplitude (HVLA) manipulation with complete resolution of her symptoms.

CLINICAL FEATURES

A 40-year-old woman developed right finger paresthesia and neck pain. Results of electrodiagnostics were normal, but clinical examination revealed subtle findings of cervical radiculopathy. A subsequent magnetic resonance imaging revealed a large right posterolateral disk protrusion and spur impinging on the right hemicord with moderate to severe central canal and right neuroforaminal stenosis at C5-6 and C6-7. She was treated with HVLA manipulation to the cervical spine, as well as soft tissue techniques, traction, nonsteroidal anti-inflammatory drugs, and exercise.

INTERVENTION AND OUTCOME

Her clinical findings and symptoms resolved within 90 days of initiating care and did not return in 1 year. There were no untoward effects, including transient ones.

CONCLUSION

This case describes the clinical presentation and course of a patient with multilevel large herniated disks and associated radiculopathy who was treated with HVLA manipulation and other conservative approaches and appeared to have good outcomes.

Chiropractic Manipulation and Acute Neck Pain: A Review of the Evidence

OBJECTIVE

The aim of this study was to review the chiropractic and medical literature in an effort to determine the extent of current evidence supporting the use of chiropractic manipulation for the treatment of acute neck pain.

METHODS

A literature search of the MEDLINE/PubMed and MANTIS (Manual Alternative and Natural Therapy Index System) databases, extending from 1966 to September 2003, was conducted. Search terms included "cervical," "neck," "chiropractic," "neck pain," "patient satisfaction," and "manipulation." The inclusion criteria for article selection were studies dealing with the treatment of neck pain by means of chiropractic manipulation, regardless of the number of subjects involved or whether randomization was implemented.

RESULTS

Two hundred sixty-seven citations were identified. Most were eliminated because they either did not specifically deal with the treatment of acute neck pain with manipulation or were not written in English. Less than 10 articles marginally dealt with the treatment of acute neck pain with cervical manipulation. Moreover, there has only been one randomized clinical trial published in the English language that specifically dealt with the treatment of acute neck pain by manipulation. Other studies involved patients with neck pain of a subacute or chronic nature or treated test subjects with mobilization techniques rather than manipulation.

CONCLUSION

There has been scant investigative research into the treatment of acute neck pain with chiropractic manipulation. Consequently, more data are needed and appropriate studies should be initiated.

Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial

BACKGROUND

Cervical lordosis has been shown to be an important outcome of care; however, few conservative methods of rehabilitating sagittal cervical alignment have been reported.

OBJECTIVE

To study whether a seated, retracted, extended, and compressed position would cause tension in the anterior cervical ligament, anterior disk, and muscle structures, and thereby restore cervical lordosis or increase the curvature in patients with loss of the cervical lordosis.

STUDY DESIGN

Nonrandomized, prospective, clinical control trial.

METHODS

Thirty preselected patients, after diagnostic screening for tolerance to cervical extension with compression, were treated for the first 3 weeks of care using cervical manipulation and a new type of cervical extension-compression traction (vertical weight applied to the subject's forehead in the sitting position with a transverse load at the area of kyphosis). Pretreatment and posttreatment Visual Analogue Scale (VAS) pain ratings were compared along with pretreatment and posttreatment lateral cervical radiographs analyzed with the posterior tangent method for changes in alignment. Results are compared to a control group of 33 subjects receiving no treatment and matched for age, sex, weight, height, and pain.

RESULTS

Control subjects reported no change in VAS pain ratings and had no statistical significant change in segmental or global cervical alignment on comparative lateral cervical radiographs (difference in all angle mean values < 1.3 degrees ) repeated an average of 8.5 months later. For the traction group, VAS ratings were 4.1 pretreatment and 1.1 posttreatment. On comparative lateral cervical radiographs repeated after an average of 38 visits over 14.6 weeks, 10 angles and 2 distances showed statistically significant improvements, including anterior head weight bearing (mean improvement of 11 mm), Cobb angle at C2-C7 (mean improvement of -13.6 degrees ), and the angle of intersection of the posterior tangents at C2-C7 (mean improvement of 17.9 degrees ). Twenty-one (70%) of the treatment group subjects were followed for an additional 14 months; improvements in cervical lordosis and anterior weight bearing were maintained.

CONCLUSIONS

Chiropractic biophysics (CBP) technique's extension-compression 2-way cervical traction combined with spinal manipulation decreased chronic neck pain intensity and improved cervical lordosis in 38 visits over 14.6 weeks, as indicated by increases in segmental and global cervical alignment. Anterior head weight-bearing was reduced by 11 mm; Cobb angles averaged an increase of 13 degrees to 14 degrees; and the angle of intersection of posterior tangents on C2 and C7 averaged 17.9 degrees of improvement.