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Haas JW, Oakley PA, Ferrantelli JR, Katz EA, Moustafa IM, Harrison DE. Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure. Diagnostics (Basel) 2024; 14:957. [PMID: 38732372 PMCID: PMC11082978 DOI: 10.3390/diagnostics14090957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to an MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve. METHODS Three spine clinic records were reviewed over a 2-year period, looking for patients where both an initial lateral cervical X-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards, an additional exam and radiographic analysis were obtained. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2-C7), Chamberlain's line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii. RESULTS There were 15 males and 26 females with an age range of 8-65 years. Most participants were drivers (28) involved in rear-end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p < 0.001. The NDI was available on 24/41 (58.5%) patients and increased after the MVC from 15.7% to 32.8%, p < 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in the mean radius of curvature (265.5 vs. 555.5, p < 0.001) and an approximate 8° reduction of lordosis from C2-C7; p < 0.001. The mid-cervical spine (C3-C5) showed the greatest curve reduction with an averaged localized mild kyphosis at these levels. Four participants (10%) developed segmental translations that were just below the threshold of instability, segmental translations < 3.5 mm. CONCLUSIONS The post-exposure MVC cervical curvature was characterized by an increase in radius of curvature, an approximate 8° reduction in C2-C7 lordosis, a mild kyphosis of the mid-cervical spine, and a slight increase in anterior translation of C2-C7 sagittal balance. The modelling result indicates that the post-MVC cervical sagittal alignment approximates a second-order buckling alignment, indicating a significant alteration in curve geometry. Future biomechanics experiments and clinical investigations are needed to confirm these findings.
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Affiliation(s)
- Jason W. Haas
- Chiropractic Biophysics NonProfit, Inc., Eagle, ID 83616, USA
| | - Paul A. Oakley
- Kinesiology and Health Science, York University, Toronto, ON M3J1P3, Canada;
| | | | | | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
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Haas JW, Oakley PA, Betz JW, Miller JE, Jaeger JO, Moustafa IM, Harrison DE. Sagittal Full-Spine vs. Sectional Cervical Lateral Radiographs: Are the Measurements of Cervical Alignment Interchangeable? J Clin Med 2024; 13:2502. [PMID: 38731030 PMCID: PMC11084776 DOI: 10.3390/jcm13092502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: This study assessed the relationship between cervical spine parameters taken on standing full-spine lateral radiographic images compared to sectional lateral cervical radiographs. (2) Methods: Full-spine (FS) and sectional lateral cervical (LC) radiographs from four spine treatment facilities across the USA retrospectively provided data collected on 220 persons to assess the comparison of three sagittal cervical radiographic measurements between the two views. The measures included cervical lordosis using the absolute rotation angle from C2-C7, sagittal cervical translation of C2-C7, and atlas plane angle to horizontal. Linear correlation and R2 models were used for statistical comparison of the measures for the two views. (3) Results: The mean values of the three measurements were statistically different from each other: C2-C7 translation (FS = 19.84 ± 11.98 vs. LC = 21.18 ± 11.8), C2-C7 lordosis (FS = -15.3 ± 14.63 vs. LC = -18.32 ± 13.16), and atlas plane (FS = -19.99 ± 8.88 vs. LC = -22.56 ± 8.93), where all values were p < 0.001. Weak-to-moderate-to-strong correlations existed between the full-spine and sectional lateral cervical radiographic variables. The R2 values varied based on the measurement were R2 = 0.768 (p < 0.001) for sagittal cervical translation of C2-C7 (strong), R2 = 0.613 (p < 0.001) for the absolute rotation angle C2-C7 (moderate), and R2 = 0.406 (p < 0.001) for the atlas plane line (weak). Though a linear correlation was identified, there were consistent intra-person differences between the measurements on the full spine versus sectional lateral cervical radiographic views, where the full-spine view consistently underestimated the magnitude of the variables. (4) Conclusion: Key sagittal cervical radiographic measurements on the full spine versus sectional lateral cervical radiographic views show striking intra-person differences. The findings of this study confirm that full spine versus sectional lateral cervical radiographic views provide different biomechanical magnitudes of cervical sagittal alignment, and caution should be exercised by health care providers as these are not interchangeable. We recommend the LC view for measurement of cervical sagittal alignment variables.
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Affiliation(s)
- Jason W. Haas
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
| | - Paul A. Oakley
- Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada;
| | - Joseph W. Betz
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Private Practice, Boise, ID 83709, USA
| | - Jason E. Miller
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Private Practice, Lakewood, CO 80226, USA
| | - Jason O. Jaeger
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Community Based Internship Program, Associate Faculty, Southern California University of Health Sciences, Whittier, CA 90604, USA
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Deed E. Harrison
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
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Malham GM, Biddau DT, Laggoune JP, Faulks CR, Walsh WR, Wang YY. Porous Cage Macro-Topography Improves Early Fusion Rates in Anterior Cervical Discectomy and Fusion. Surg Res Pract 2024; 2024:8452050. [PMID: 38523843 PMCID: PMC10957252 DOI: 10.1155/2024/8452050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives Anterior cervical discectomy and fusion (ACDF) aims to improve pain, relieve neural compression, achieve rapid solid bony arthrodesis, and restore cervical alignment. Bony fusion occurs as early as 3 months and up to 24 months after ACDF. The correlations between bony fusion and clinical outcomes after ACDF remain unclear. Macro-topographic and porous features have been introduced to interbody cage technology, aiming to improve the strength of the bone-implant interface to promote early fusion. In this study, we aimed to compare clinical outcomes and CT-evaluated fusion rates in patients undergoing ACDF using one of two different interbody cages: traditional NanoMetalene™ (NM) cages and NM cages with machined porous features (NMRT). Methods This was a prospective, observational, nonrandomised, cohort study of consecutive patients undergoing ACDF. The NM cage cohort was enrolled first, then the NMRT cohort second. The visual analogue scale, neck disability index, and 12-item Short Form Survey scores were evaluated preoperatively and at 6 weeks, 3 months, and 6 months. The minimum clinical follow-up period was 12 months. Plain radiographs were obtained on postoperative day 2 to assess instrumentation positioning, and computed tomography (CT) was performed at 3 and 6 months postoperatively to assess interbody fusion (Bridwell grade). Results Eighty-nine (52% male) patients with a mean age of 62 ± 10.5 years were included in this study. Forty-one patients received NM cages, and 48 received NMRT cages. All clinical outcomes improved significantly from baseline to 6 months. By 3 months, the NMRT group had significantly higher CT fusion rates than the NM group (79% vs 56%, p=0.02). By 6 months, there were no significant differences in fusion rates between the NMRT and NM groups (83% vs 78%, p=0.69). The mean Bridwell grade at 6 months was 1.4 ± 0.7 in the NMRT group and 1.8 ± 1.0 in the NM group (p=0.08). Conclusions With both NM and NMRT cages, serial improvements in postoperative clinical outcomes were associated with fusion progression on CT. NMRT cages demonstrated significantly better fusion at 3 months and a trend toward higher quality of fusion at 6 months compared with NM cages, suggesting earlier cage integration with NMRT. An early 3-month postoperative CT is adequate for fusion assessment in almost 80% of patients undergoing ACDF with an NMRT cage, permitting an earlier return to activity.
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Affiliation(s)
- Gregory M. Malham
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Spine Surgery Research, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Dean T. Biddau
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jordan P. Laggoune
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
| | - Charlie R. Faulks
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
| | - William R. Walsh
- Surgical & Orthopaedic Research Laboratories (SORL), UNSW Sydney, Prince of Wales Clinical School, Prince of Wales Hospital, Sydney, Australia
| | - Yi Yuen Wang
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
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Norton TC, Oakley PA, Harrison DE. Re-establishing the cervical lordosis after whiplash: a Chiropractic Biophysics ® spinal corrective care methods pre-auto injury and post-auto injury case report with follow-up. J Phys Ther Sci 2023; 35:270-275. [PMID: 36866005 PMCID: PMC9974326 DOI: 10.1589/jpts.35.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/06/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] To document the re-establishment of the cervical lordosis following radiographically verified altered sagittal plane alignment both prior to, and following a motor vehicle collision. [Participant and Methods] A 16-year-old male presented for a non-motor collision complaint of low back pain. Initial lateral cervical radiograph demonstrated cervical hypo-lordosis. The patient was treated with a 6-week plan (18 visits) utilizing Chiropractic BioPhysics® (CBP) methods to increase the cervical lordosis. Eight months later the patient presented with new complaints as a result of a motor collision. The cervical lordosis straightened. The patient received another round of similar treatment to improve the lordosis. There was also a 6.5-month follow-up. [Results] The initial round of treatment achieved a 21° improvement in cervical lordosis. The motor vehicle collision caused a loss of 15° of lordosis. The second round of treatment achieved a 12.5° improvement in lordosis that was demonstrated to be maintained at a 6.5-month follow-up. [Conclusions] This case illustrates how a whiplash event occurring during a motor vehicle collision subluxated the cervical spine. It was also shown that CBP methods reliably corrected the lordosis after two separate treatment programs using specialized methods. Beyond trauma, radiographic screening of specific cervical subluxation is recommended following all motor collisions.
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Affiliation(s)
| | - Paul A. Oakley
- Private Practice: 11A-1100 Gorham St., Newmarket, Ontario
L3Y8Y8, Canada,Corresponding author. Paul A. Oakley (E-mail: )
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İplikçioğlu AC, Karabağ H. Analysis of Components of Upper Cervical Lordosis in Asymptomatic Lordotic and Kyphotic Subjects. World Neurosurg 2023; 171:e852-e858. [PMID: 36608798 DOI: 10.1016/j.wneu.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Upper cervical lordosis (CL) can be divided into 2 components: C2 slope (C2S) and McGregor slope (MGS) or C0-1 and C1-2 angles. The aim of this study was to investigate the components of upper CL in asymptomatic kyphotic and lordotic subjects. METHODS CL, C0-2 Cobb angle, MGS, C2S, C1 Slope, C0-1 Cobb angle, C1-2 Cobb angle, T1 slope angular parameters, and the C2-7 sagittal vertical axis distance of 78 asymptomatic subjects were measured. RESULTS Sixty subjects had lordotic curvature and 18 had kyphotic curvature. There was a significant difference between the kyphotic and lordotic groups in all parameters, except for C0-1 Cobb angle and C2-7 sagittal vertical axis. In lordotic subjects, MGS and C2S accounted for 58% and 42% of the C0-2 angle, whereas in kyphotic subjects, 86% of C0-2 was accounted for by C2S. There was a strong negative correlation between C2S and MGS. CONCLUSIONS In asymptomatic subjects, as CL decreases, MGS decreases, C2S increases, and the C0-2 angle turns down on the horizontal plane to maintain the horizontal gaze. Turning down the C0-2 angle is more important than its value for maintaining horizontal gaze; thus, the slopes (MGS and C2S) can better represent the upper and lower cervical alignment than angle values can. The relationship between upper and lower cervical alignment should be evaluated in terms of slope angles rather than simple angles. The lack of significant difference between the C0-1 angles in the kyphotic and lordotic groups suggests that only the C1-2 angle is involved in the compensatory mechanism for the horizontal gaze.
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Affiliation(s)
| | - Hamza Karabağ
- Department of Neurosurgery, Harran Üniversity, Şanlıurfa, Turkey.
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Daniel ES, Lee RYW, Williams JM. The reliability of video fluoroscopy, ultrasound imaging, magnetic resonance imaging and radiography for measurements of lumbar spine segmental range of motion in-vivo: A review. J Back Musculoskelet Rehabil 2023; 36:117-135. [PMID: 35988213 DOI: 10.3233/bmr-210285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lower back pain (LBP) is a principal cause of disability worldwide and is associated with a variety of spinal conditions. Individuals presenting with LBP may display changes in spinal motion. Despite this, the ability to measure lumbar segmental range of motion (ROM) non-invasively remains a challenge. OBJECTIVE To review the reliability of four non-invasive modalities: Video Fluoroscopy (VF), Ultrasound imaging (US), Magnetic Resonance Imaging (MRI) and Radiography used for measuring segmental ROM in the lumbar spine in-vivo. METHODS The methodological quality of seventeen eligible studies, identified through a systematic literature search, were appraised. RESULTS The intra-rater reliability for VF is excellent in recumbent and upright positions but errors are larger for intra-rater repeated movements and inter-rater reliability shows larger variation. Excellent results for intra- and inter-rater reliability are seen in US studies and there is good reliability within- and between-day. There is a large degree of heterogeneity in MRI and radiography methodologies but reliable results are seen. CONCLUSIONS Excellent reliability is seen across all modalities. However, VF and radiography are limited by radiation exposure and MRI is expensive. US offers a non-invasive, risk free method but further research must determine whether it yields truly consistent measurements.
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Affiliation(s)
| | - Raymond Y W Lee
- Faculty of Technology, University of Portsmouth, Portsmouth, UK
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Okonkwo UC, Ohagwu CC, Aronu ME, Okafor CE, Idumah CI, Okokpujie IP, Chukwu NN, Chukwunyelu CE. Ionizing radiation protection and the linear No-threshold controversy: Extent of support or counter to the prevailing paradigm. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2022; 253-254:106984. [PMID: 36057228 DOI: 10.1016/j.jenvrad.2022.106984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
This study has developed a relationship that categorized radiation protection and allows for a proper, clear, and concise review of the different classifications in terms of principles of protection, dose criteria, categories, fundamental tools, exposure situations, applications and control measures. With the groundwork laid, advances of the linear no-threshold (LNT) model which has attracted attention in the field of radiobiology and epidemiology were examined in detail. Various plausible dose-response relationship scenarios were x-rayed under low-dose extrapolation. Intensive review of factors opposing the LNT model involving radiophobia (including misdiagnosis, alternative surgery/imaging, suppression of ionizing radiation (IR) research); radiobiology (including DNA damage repair, apoptosis/necrosis, senescence protection) and cost issues (including-high operating cost of LNT, incorrect prioritization, exaggeration of LNT impact, risk-to-benefit analysis) were performed. On the other hand, factors supporting the use of LNT were equally examined, they include regulatory bodies' endorsement, insufficient statistical significance, partial DNA repair, variability of irradiated bodies, different latency periods for cancer, dynamic nature of threshold and conflicting interests. After considering the gaps in the scientific investigations that either support or counter the scientific paradigm on the use of LNT model, further research and advocacy is recommended that will ultimately lead to the acceptance of an alternative paradigm by the international regulators.
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Affiliation(s)
- Ugochukwu C Okonkwo
- Department of Mechanical Engineering, Nnamdi Azikiwe University, Awka, Nigeria.
| | - Christopher C Ohagwu
- Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Michael E Aronu
- Department of Radiology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Christian E Okafor
- Department of Mechanical Engineering, Nnamdi Azikiwe University, Awka, Nigeria
| | - Christopher I Idumah
- Department of Polymer and Textile Engineering, Nnamdi Azikiwe University, Awka, Nigeria
| | - Imhade P Okokpujie
- Department of Mechanical and Mechatronic Engineering, Afe-Babalola University, Ado-Ekiti, Nigeria
| | - Nelson N Chukwu
- National Engineering Design Development Institute, Nnewi, Anambra State, Nigeria
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Mehkri Y, McDonald B, Sriram S, Reddy R, Kounelis-Wuillaume S, Roberts JA, Lucke-Wold B. Recent Treatment Strategies in Alzheimer's Disease and Chronic Traumatic Encephalopathy. BIOMEDICAL RESEARCH AND CLINICAL REVIEWS 2022; 7:128. [PMID: 36743825 PMCID: PMC9897211 DOI: 10.31579/2692-9406/128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Neurotrauma has been well linked to the progression of neurodegenerative disease. Much work has been done characterizing chronic traumatic encephalopathy, but less has been done regarding the contribution to Alzheimer's Disease. This review focuses on AD and its association with neurotrauma. Emerging clinical trials are discussed as well as novel mechanisms. We then address how some of these mechanisms are shared with CTE and emerging pre-clinical studies. This paper is a user-friendly resource that summarizes the emerging findings and proposes further investigation into key areas of interest. It is intended to serve as a catalyst for both research teams and clinicians in the quest to improve effective treatment and diagnostic options.
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Affiliation(s)
- Yusuf Mehkri
- Department of Neurosurgery, University of Florida, Gainesville
| | | | - Sai Sriram
- Department of Neurosurgery, University of Florida, Gainesville
| | - Ramya Reddy
- Department of Neurosurgery, University of Florida, Gainesville
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DeNunzio G, Evans T, Beebe ME, Browning J, Koivisto J. Craniocervical Junction Visualization and Radiation Dose Consideration Utilizing Cone Beam Computed Tomography for Upper Cervical Chiropractic Clinical Application a Literature Review. Dose Response 2022; 20:15593258221107515. [PMID: 35719850 PMCID: PMC9201332 DOI: 10.1177/15593258221107515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To highlight the detail obtained on a Cone Beam Computed Tomography (CBCT) scan of the craniocervical junction and its usefulness to Chiropractors who specialize in the upper cervical spine. A review of the dose considerations to patients vs radiography in a chiropractic clinical setting and to review the effective radiation dose to the patient. Methods A review of studies discussing cervical biomechanics, neurovascular structures, and abnormal radiographic findings, was discussed in relation to chiropractic clinical relevance. Further studies were evaluated demonstrating radiation dose to the patient from radiographs compared to CBCT. Results Incidental and abnormal findings of the craniocervical junction were shown to have superior visualization with CBCT compared to radiography. The radiation dose to the patient for similar imaging protocols to the craniocervical junction and cervical spine was equal or less utilizing CBCT when compared to radiographs. Conclusions The use of CBCT for visualization of the craniocervical junction and cervical spine in the chiropractic clinical setting allows for adjunctive visualization of the osseous structures which is germane to clinical protocol. Further with CBCT the effective dose to the patient is equal or less than similar imaging protocols utilizing radiographs to evaluate the craniocervical junction.
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Affiliation(s)
- Greg DeNunzio
- Sweere Center for Clinical Biomechanics and Applied Ergonomics, Northwestern Health Sciences University, Bloomington, MI, USA
| | - Tyler Evans
- Private Practice, Arete Chiropractic, Portsmouth, NH, USA
| | - Mychal E Beebe
- Private Practice, Arete Chiropractic, Portsmouth, NH, USA
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Kallan SZ, Oakley PA, Harrison DE. Reduction of lumbar hyperlordosis in a pediatric: a Chiropractic Biophysics<sup>®</sup> case report. J Phys Ther Sci 2022; 34:646-650. [PMID: 36118660 PMCID: PMC9444519 DOI: 10.1589/jpts.34.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To demonstrate the reduction of lumbar hyperlordosis, sacral base angle and
anterior thoracic translation posture in an 11-year-old female. [Participant and Methods]
A pediatric patient presented with lumbar hyperlordosis and underwent Chiropractic
BioPhysics® treatment protocols to reduce her spinal deformity and correlated
symptoms. Symptoms included thoracolumbar, hip, knee and ankle pains and lower extremity
weakness. Radiographs confirmed lumbar hyperlordosis, increased sacral base angle and a
forward translated thoracic posture. Spinal traction as well as corrective exercises and
spinal manipulative therapy was performed over an 11-month period. [Results] After 57
treatments, there was a 13.4° reduction in L1-L5 lordosis, an 11.8° reduction in sacral
base angle and a 13.8 mm reduction in anterior thoracic translation. The improved
structural changes correlated with improved symptoms. [Conclusion] Lumbar hyperlordosis
can be reduced in pediatric patients presenting with hyperlordosis and associated
symptomatology. Routine radiography may be warranted in the diagnosis of lumbar spine
deformities in pediatrics. Further research into the non-surgical reduction of lumbar
spine hyperlordosis is needed.
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Oakley PA, Betz JW, Harrison DE, Siskin LA, Hirsh DW. Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering. Dose Response 2021; 19:15593258211033142. [PMID: 34421439 PMCID: PMC8375354 DOI: 10.1177/15593258211033142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
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Affiliation(s)
| | | | | | | | | | - International Chiropractors Association Rapid Response Research Review Subcommittee
- Private Practice, Newmarket, ON, Canada
- Private Practice, Boise, ID, USA
- CBP NonProfit, Inc, Eagle, ID, USA
- Private Practice, Green Brook, NJ, USA
- Private Practice, Laurel, MD, USA
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Oakley PA, Harrison DE. Radiophobic Fear-Mongering, Misappropriation of Medical References and Dismissing Relevant Data Forms the False Stance for Advocating Against the Use of Routine and Repeat Radiography in Chiropractic and Manual Therapy. Dose Response 2021; 19:1559325820984626. [PMID: 33628151 PMCID: PMC7883173 DOI: 10.1177/1559325820984626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
There is a faction within the chiropractic profession passionately advocating against the routine use of X-rays in the diagnosis, treatment and management of patients with spinal disorders (aka subluxation). These activists reiterate common false statements such as "there is no evidence" for biomechanical spine assessment by X-ray, "there are no guidelines" supporting routine imaging, and also promulgate the reiterating narrative that "X-rays are dangerous." These arguments come in the form of recycled allopathic "red flag only" medical guidelines for spine care, opinion pieces and consensus statements. Herein, we review these common arguments and present compelling data refuting such claims. It quickly becomes evident that these statements are false. They are based on cherry-picked medical references and, most importantly, expansive evidence against this narrative continues to be ignored. Factually, there is considerable evidential support for routine use of radiological imaging in chiropractic and manual therapies for 3 main purposes: 1. To assess spinopelvic biomechanical parameters; 2. To screen for relative and absolute contraindications; 3. To reassess a patient's progress from some forms of spine altering treatments. Finally, and most importantly, we summarize why the long-held notion of carcinogenicity from X-rays is not a valid argument.
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Oakley PA, Harrison DE. X-ray Hesitancy-Response to Jargin and Sohrabi. Dose Response 2020; 18:1559325820982425. [PMID: 33414696 PMCID: PMC7750766 DOI: 10.1177/1559325820982425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022] Open
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Oakley PA, Navid Ehsani N, Harrison DE. 5 Reasons Why Scoliosis X-Rays Are Not Harmful. Dose Response 2020; 18:1559325820957797. [PMID: 32963506 PMCID: PMC7488912 DOI: 10.1177/1559325820957797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Radiographic imaging for scoliosis screening, diagnosis, treatment, and management is the gold standard assessment tool. Scoliosis patients receive many repeat radiographs, typically 10-25 and as many as 40-50, equating to a maximum 50 mGy of cumulative exposure. It is argued this amount of radiation exposure is not carcinogenic to scoliosis patients for 5 main reasons: 1. Estimated theoretical cumulative effective doses remain below the carcinogenic dose threshold; 2. Scoliosis patient x-rays are delivered in serial exposures and therefore, mitigate any potential cumulative effect; 3. Linear no-threshold cancer risk estimates from scoliosis patient cohorts are flawed due to faulty science; 4. Standardized incidence/mortality ratios demonstrating increased cancers from aged scoliosis cohorts are confounded by the effects of the disease entity itself making it impossible to claim cause and effect resulting from low-dose radiation exposures from spinal imaging; 5. Children are not more susceptible to radiation damage than adults. Radiophobia concerns from patients, parents, and doctors over repeat imaging for scoliosis treatment and management is not justified; it adds unnecessary anxiety to the patient (and their parents) and interferes with optimal medical management. X-rays taken in the evidence-based management of scoliosis should be taken without hesitation or concern about negligible radiation exposures.
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Oakley PA, Harrison DE. X-Ray Hesitancy: Patients' Radiophobic Concerns Over Medical X-rays. Dose Response 2020; 18:1559325820959542. [PMID: 32994755 PMCID: PMC7503016 DOI: 10.1177/1559325820959542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
All too often the family physician, orthopedic surgeon, dentist or chiropractor is met with radiophobic concerns about X-ray imaging in the clinical setting. These concerns, however, are unwarranted fears based on common but ill-informed and perpetuated ideology versus current understanding of the effects of low-dose radiation exposures. Themes of X-ray hesitancy come in 3 forms: 1. All radiation exposures are harmful (i.e. carcinogenic); 2. Radiation exposures are cumulative; 3. Children are more susceptible to radiation. Herein we address these concerns and find that low-dose radiation activates the body's adaptive responses and leads to reduced cancers. Low-dose radiation is not cumulative as long as enough time (e.g. 24 hrs) passes prior to a repeated exposure, and any damage is repaired, removed, or eliminated. Children have more active immune systems; the literature shows children are no more affected than adults by radiation exposures. Medical X-rays present a small, insignificant addition to background radiation exposure that is not likely to cause harm. Doctors and patients alike should be better informed of the lack of risks from diagnostic radiation and the decision to image should rely on the best evidence, unique needs of the patient, and the expertise of the physician-not radiophobia.
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Oakley PA, Harrison DE. Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association's Adoption of "Choosing Wisely". Dose Response 2020; 18:1559325820919321. [PMID: 32425722 PMCID: PMC7218311 DOI: 10.1177/1559325820919321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 12/18/2022] Open
Abstract
Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting "Choosing Wisely," we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.
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Oakley PA, Harrison DE. Death of the ALARA Radiation Protection Principle as Used in the Medical Sector. Dose Response 2020; 18:1559325820921641. [PMID: 32425724 PMCID: PMC7218317 DOI: 10.1177/1559325820921641] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
ALARA is the acronym for "As Low As Reasonably Achievable." It is a radiation protection concept borne from the linear no-threshold (LNT) hypothesis. There are no valid data today supporting the use of LNT in the low-dose range, so dose as a surrogate for risk in radiological imaging is not appropriate, and therefore, the use of the ALARA concept is obsolete. Continued use of an outdated and erroneous principle unnecessarily constrains medical professionals attempting to deliver high-quality care to patients by leading to a reluctance by doctors to order images, a resistance from patients/parents to receive images, subquality images, repeated imaging, increased radiation exposures, the stifling of low-dose radiation research and treatment, and the propagation of radiophobia and continued endorsement of ALARA by regulatory bodies. All these factors result from the fear of radiogenic cancer, many years in the future, that will not occur. It has been established that the dose threshold for leukemia is higher than previously thought. A low-dose radiation exposure from medical imaging will likely upregulate the body's adaptive protection systems leading to the prevention of future cancers. The ALARA principle, as used as a radiation protection principle throughout medicine, is scientifically defunct and should be abandoned.
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Agathokleous E, Calabrese EJ. A global environmental health perspective and optimisation of stress. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 704:135263. [PMID: 31836236 DOI: 10.1016/j.scitotenv.2019.135263] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 05/17/2023]
Abstract
The phrase "what doesn't kill us makes us stronger" suggests the possibility that living systems have evolved a spectrum of adaptive mechanisms resulting in a biological stress response strategy that enhances resilience in a targeted quantifiable manner for amplitude and duration. If so, what are its evolutionary foundations and impact on biological diversity? Substantial research demonstrates that numerous agents enhance biological performance and resilience at low doses in a manner described by the hormetic dose response, being inhibitory and/or harmful at higher doses. This Review assesses how environmental changes impact the spectrum and intensity of biological stresses, how they affect health, and how such knowledge may improve strategies in confronting global environmental change.
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Affiliation(s)
- Evgenios Agathokleous
- Institute of Ecology, School of Applied Meteorology, Nanjing University of Information Science and Technology (NUIST), Ningliu Rd. 219, Nanjing, Jiangsu 210044, China.
| | - Edward J Calabrese
- Professor of Toxicology, Department of Environmental Health Sciences, Morrill I, N344; University of Massachusetts, Amherst, MA 01003 USA
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Oakley PA, Ehsani NN, Harrison DE. Repeat Radiography in Monitoring Structural Changes in the Treatment of Spinal Disorders in Chiropractic and Manual Medicine Practice: Evidence and Safety. Dose Response 2019; 17:1559325819891043. [PMID: 31839759 PMCID: PMC6900628 DOI: 10.1177/1559325819891043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
There is substantial evidence for normal relationships between spine and postural
parameters, as measured from radiographs of standing patients. Sagittal balance,
cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, and the more
complex understanding of the interrelations between these essential components
of normal stance have evolved to where there are known, established thresholds
for normalcy. These spinal parameters are reliably measured from X-ray images
and serve as goals of care in the treatment of spine and postural disorders.
Initial and follow-up spinal imaging by X-ray is thus crucial for the practice
of contemporary and evidence-based structural rehabilitation. Recent studies
have demonstrated that improvement in the spine and posture by nonsurgical
methods offers superior long-term patient outcomes versus conventional methods
that only temporarily treat pain/dysfunction. Low-dose radiation from repeated
X-ray imaging in treating subluxated patients is substantially below the known
threshold for harm and is within background radiation exposures. Since
alternative imaging methods are not clinically practical at this time, plain
radiography remains the standard for spinal imaging. It is safe when used in a
repeated fashion for quantifying pre–post spine and postural subluxation and
deformity patterns in the practice of structural correction methods by
chiropractic and other manual medicine practices.
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Oakley PA, Ehsani NN, Harrison DE. Non-surgical reduction of lumbar hyperlordosis, forward sagittal balance and sacral tilt to relieve low back pain by Chiropractic BioPhysics ® methods: a case report. J Phys Ther Sci 2019; 31:860-864. [PMID: 31645820 PMCID: PMC6801353 DOI: 10.1589/jpts.31.860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To present the reduction of both lumbar spine hyperlordosis and anterior sagittal balance in a symptomatic patient as treated by Chiropractic BioPhysics® technique. [Participant and Methods] A 46 year old reported with low back and hip pains for six years. Oswestry disability index scored 28%. Radiographic assessment revealed pronounced anterior sagittal balance with lumbar hyperlordosis. The patient was treated by Chiropractic BioPhysics technique to reverse the spinal deformity subluxation via mirror image corrective exercises and spinal traction, as well as spinal manipulative therapy. [Results] Assessments after 36 and 74 treatments corresponding to the 4-month and 13-month check-ups demonstrated a continuous structural improvement in lumbar spine biomechanical parameters. There was a near complete resolution in low back and hip pains with an Oswestry score of 4%. [Conclusion] This case documents the reduction of lumbar spine hyperlordosis and forward sagittal balance by contemporary spine rehabilitation methods. It is essential to screen spinal subluxation patterns via standing radiography which obviously, as demonstrated in this case determines treatment approach as most low back pain patients present with lumbar hypolordosis. Routine initial and repeat radiography is safe in the screening and monitoring of treatment efficacy and is the standard for evidence-based, patient-centred structural rehabilitation.
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Gubbels CM, Werner JT, Oakley PA, Harrison DE. Reduction of thoraco-lumbar junctional kyphosis, posterior sagittal balance, and increase of lumbar lordosis and sacral inclination by Chiropractic BioPhysics ® methods in an adolescent with back pain: a case report. J Phys Ther Sci 2019; 31:839-843. [PMID: 31645816 PMCID: PMC6801338 DOI: 10.1589/jpts.31.839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
[Purpose] To present the structural improvement of an excessive junctional thoracolumbar kyphosis and related biomechanical parameters in an adolescent. [Participant and Methods] A 16 year old female presented with chronic back pains. Radiographic assessment revealed excessive posterior sagittal balance and thoracolumbar kyphosis and reduced lumbar lordosis and sacral inclination. Chiropractic BioPhysics® technique including mirror image®, anterior thoracic translation and thoracolumbar hyperextension traction was performed as well as spinal manipulation and postural exercises over an 8-week period. [Results] After 24 in-office treatments and a daily home program the patient reported a minimization of back pains and a better mood. Follow-up X-rays demonstrated a 48 mm reduction of posterior sagittal balance, a 22° reduction of thoracolumbar kyphosis, an 11° increase in lumbar lordosis, and a 10° increase in sacral inclination. [Conclusion] This is the first case documenting the non-surgical reduction of excessive thoracolumbar junctional kyphosis and related biomechanical parameters in an adolescent. Precise analysis of radiologic assessment for adolescents presenting with back pains is advised and are safe for the screening of postural disorders. There is a growing evidence base for the Chiropractic BioPhysics® technique approach in the correction of lumbar spine disorders; more research is encouraged to further evaluate this unique treatment.
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Affiliation(s)
| | | | - Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, ON, L3Y 8Y8, Canada
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Jones AK, O’Connor MK, Zaidi H. The eventual rejection of the linear no‐threshold theory will lead to a drastic reduction in the demand for diagnostic medical physics services. Med Phys 2019; 46:3325-3328. [DOI: 10.1002/mp.13619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/06/2019] [Accepted: 05/17/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Aaron Kyle Jones
- MD Anderson Cancer Center Department of Imaging Physics Houston TX USA
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Anderson JM, Oakley PA, Harrison DE. Improving posture to reduce the symptoms of Parkinson's: a CBP ® case report with a 21 month follow-up. J Phys Ther Sci 2019; 31:153-158. [PMID: 30858655 PMCID: PMC6382490 DOI: 10.1589/jpts.31.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 01/30/2023] Open
Abstract
[Purpose] To demonstrate the reduction of symptoms related to Parkinson’s disease by
improvement in posture. [Participant and Methods] A 59-year-old male patient presented
with a prior diagnosis of Parkinson’s. Symptoms included a resting right hand tremor,
intermittent ‘freezing episodes’ with gait, mild ataxia with shuffling on toes and
bradykinesia assisted with a cane, as well as low back pain and right knee pain.
Radiography revealed gross postural and spine deformity. The patient received Chiropractic
BioPhysics care including mirror image exercises, spinal traction, spinal adjustments as
well as gait rehabilitation. [Results] After 38 treatments over 5 months, the patient had
significant improvements in posture alignment as well as gait, balance, hand tremors, low
back and knee pains and SF-36 values. A 21 month follow-up revealed the patient had
remained essentially well and the initial postural improvements were maintained.
[Conclusion] This case demonstrates improvement of various symptoms in a patient with
Parkinson’s disease. Since poor posture is a long known clinical manifestation of this
disorder, it is proposed that the improvement of posture in these patients may lead to
improved outcomes. X-ray use in the diagnosis and management in those with spine deformity
is safe and not carcinogenic.
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Affiliation(s)
| | - Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, Ontario L3Y8Y8, Canada
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Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap 2018; 26:48. [PMID: 30479744 PMCID: PMC6247638 DOI: 10.1186/s12998-018-0217-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022] Open
Abstract
The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.
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Affiliation(s)
- Hazel J Jenkins
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Aron S Downie
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Craig S Moore
- 2Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Simon D French
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.,3School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada
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Weiner MT, Oakley PA, Dennis AK, Shapiro DA, Harrison DE. Increasing the cervical and lumbar lordosis is possible despite overt osteoarthritis and spinal stenosis using extension traction to relieve low back and leg pain in a 66-year-old surgical candidate: a CBP ® case report. J Phys Ther Sci 2018; 30:1364-1369. [PMID: 30464366 PMCID: PMC6220102 DOI: 10.1589/jpts.30.1364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present the case of the dramatic relief of low back pain, leg pain and
disability in an older female with osteoarthritis, lumbar spinal stenosis and hypolordosis
of the cervical and lumbar spine. [Participant and Methods] A 66-year-old female presented
with chronic low back pain, right leg pain, numbness and weakness. Despite being
recommended for surgery, the patient sought alternative treatment. The patient was treated
with Chiropractic BioPhysics® rehabilitation of the spine with the objective to
increase the lumbar and cervical lordoses. Cervical and lumbar extension exercises and
traction were performed as well as spinal manipulation. Treatment was performed
approximately three times per week for 6.5 months. [Results] Re-assessment after treatment
demonstrated significant reduction of low back pain, leg pain and other health
improvements. X-rays showed structural improvements in the cervical and lumbar spine
despite advanced osteoarthritis. [Conclusion] Lumbar and cervical hypolordosis subluxation
may be increased in those with spinal deformity caused symptoms, despite the presence of
osteoarthritis and degenerative stenosis of the spine. Spinal x-rays as used in the
assessment and monitoring of patients being treated with contemporary spinal
rehabilitation methods are not harmful and should be used for routine screening
purposes.
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