Chiropractic Practice in the Continent of Africa: A Structured Online Survey of 608 Chiropractors.

OBJECTIVES: The purpose of this study was to assess the status, supply, demographics, and characteristics of chiropractic practice in the continent of Africa. METHODS: A survey consisting of questions on demographics, clinical practice, and patient profile was administered to 608 chiropractors practicing in the different countries of the African continent. Chiropractic association officers of each country were contacted via e-mail for assistance in the distribution of the survey link to chiropractors in their country. The initial questionnaire was pretested with a small group of chiropractors from 2 African countries-4 from Ethiopia and 6 from Botswana-to assess the validity of the questions. The legal status of the chiropractic practice was obtained from online resources. Descriptive statistics were conducted in Microsoft Excel. RESULTS: Of the 54 countries in the continent of Africa, 23 countries were identified to have chiropractors. One hundred twenty-four surveys were returned from 15 countries with an overall response rate of 20.3% by clinicians with varying years in clinical practice. Nearly 84% of the chiropractors were between ages 26 and 50. More than 69% reported being a graduate of 1 of the 2 academic institutions located in Africa. Most chiropractors practice in South Africa. Most chiropractors practice in privately owned clinics, and 38% practice in multidisciplinary clinics. Nearly 92% reported using diversified technique and 27% used McKenzie exercises for treatment. Patients presented with a variety of conditions, predominantly chronic pain (59%). CONCLUSIONS: This study provides a general overview on the status, supply, demographics, and characteristics of chiropractic practice in the continent of Africa. The supply of chiropractors in Africa is scarce and unevenly distributed. Although in the early stages of recognition, chiropractors in Africa are contributing to the care of people with musculoskeletal and spine-related disorders. Considering the high burden of spine pain, there appears to be potential for growth for chiropractic in the continent of Africa.

Cervical Vertebral Body Erosion Due to Vascular Abnormality: A Case Report.

OBJECTIVE: The occurrence of cervical vertebral erosion due to vertebral artery (VA) abnormalities such as tortuosity/loop formation and pseudoaneurysm is rare, but both abnormalities are potentially fatal. There are few reports of cervical vertebral body erosion due to VA abnormality. We report a case of a 92-year-old woman who presented to her primary care physician with neck pain and was referred for chiropractic care. CLINICAL FEATURES: The patient complained of headaches, left-sided neck pain, limited range of motion with radiating pain, and bilateral weakness of the upper extremities. On examination, cervical ranges of motion were decreased with moderate pain, along with sensory, motor, and deep tendon reflex deficits. The initial magnetic resonance imaging report obtained was nonconclusive. Axial T2, sagittal T1, sagittal T2, coronal T2, sagittal STIR, and axial GE sequences of the cervical spine were obtained for a reread. A reread of the magnetic resonance images suggested a diagnosis of a tortuosity of the VA, resulting in a chronic erosion of the C5 vertebral body; however, a pseudoaneurysm of the VA would be considered a possible differential cause for the vertebral body erosion. INTERVENTION AND OUTCOME: Management of cervical vertebral body erosion due to VA abnormality is often complicated and must be tailored to each patient's individual clinical presentation and symptoms. The patient in this case was managed with anticoagulant medication, close monitoring, and acupuncture treatment, which resulted in a reduction in pain intensity. CONCLUSION: Vertebral artery abnormality and subsequent erosion of the vertebral body is a rare occurrence and can mimic symptoms of musculoskeletal neck pain and cervical radiculopathy. It is important to recognize features of VA abnormalities on magnetic resonance imaging.