Notalgia Paresthetica Responding Positively to Chiropractic Spinal Manipulation: A Case Report.

Notalgia paresthetica (NP) is a chronic cutaneous neuropathy characterized by localized pruritus and pain, numbness, and/or paresthesia, often linked to degenerative cervicothoracic changes. Treatment options for NP are limited. This case report details a 54-year-old woman with a six-year history of right-sided periscapular pruritus and cervicothoracic discomfort who presented to a chiropractor upon referral with a prior diagnosis of NP. Prior topical treatments yielded minimal relief. Radiographs revealed degenerative spinal changes at C5/6 and C6/7 which correlated with her periscapular symptom distribution. The patient responded positively to chiropractic spinal manipulative therapy (SMT), focusing on the cervicothoracic region, coupled with myofascial release. Symptoms significantly improved after a single SMT session and resolved after a second session, with no pruritus returning over one-month follow-up. While this case highlights the potential benefits of SMT for NP, further research is needed to explore the effectiveness of this treatment.

Chiropractic Management of Lumbar Disc Herniation in a Patient With Co-existing Liver Cancer: A Case Report.

The current case report outlines the chiropractic management of a 30-year-old male construction worker who presented with symptoms of lumbar disc herniation with co-existing stage IV liver cancer. The patient reported experiencing substantial lower back pain and decreased sensation in his right leg following a fall at work, impacting his mobility and quality of life. The complexity of this case is underscored by the challenge of differentiating between pain due to metastatic disease and that related to the fall. The chiropractic treatment plan included gentle joint mobilization, instrument-assisted soft tissue mobilization, and low-impact exercises tailored to the patient's overall health status. The treatment protocol markedly improved pain levels, range of motion, and overall quality of life. This case highlights the potential role of chiropractic care in managing complex cases of lumbar disc herniation, even in the presence of severe illnesses such as liver cancer. This study provides valuable insights into the importance of personalized and adaptable treatment strategies in managing such cases, contributing a unique perspective to the scientific literature.

Multimodal Management of Coexisting Atlantoaxial Subluxation and Spinal Stenosis in an Older Adult: A Case Report and Literature Review.

This case report investigates the diagnostic and therapeutic challenges caused by the coexistence of atlantoaxial subluxation and spinal stenosis in a 70-year-old male patient with chronic progressive numbness in both hands. A detailed assessment showed that the patient's symptoms were primarily caused by spinal stenosis, not atlantoaxial subluxation. Considering the patient's age and preference for nonsurgical treatment, a conservative chiropractic care plan was implemented, significantly improving his symptoms and quality of life. This case highlights the potential benefit of conservative chiropractic care in managing such complex cases, emphasizes the need for meticulous diagnosis, and requires further research to validate these findings and develop comprehensive management guidelines.

An Adult Patient With Acute Ischemic Stroke and Carotid Stenosis Presenting to a Chiropractor: A Case Report.

A 59-year-old male, with a recent history of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, presented to a chiropractor with a one-week history of numbness in the right upper and lower extremity that was triggered by neck movement, and lightheadedness/dizziness. On examination, the chiropractor noted limited, painful cervical spine range of motion, right upper extremity weakness, patellar hyperreflexia, positive Hoffman's and Trömner's signs bilaterally, nystagmus, a sluggish right pupillary light reflex, and carotid bruit. Cervical radiographs were suggestive of Klippel-Feil syndrome. The chiropractor suspected a vascular cause such as a transient ischemic attack and referred the patient to the emergency department, which the patient visited the following day. The patient was admitted, and MRI revealed multiple tiny acute to subacute cortical infarcts of the left frontal and parietal lobes while sonography demonstrated left internal carotid artery stenosis. The patient was treated with anticoagulant and antiplatelet medications and carotid endarterectomy with a positive outcome. Given the overlap between symptoms of stroke and those of the cervical spine, chiropractors should be prepared to recognize potential stroke patients and refer them for emergent medical management.

Improvement of Chronic Neck Pain After Posterior Atlantoaxial Surgical Fusion via Multimodal Chiropractic Care: A Case Report.

There is a lack of research regarding the effectiveness and safety of manual therapies, including spinal manipulative therapy (SMT), for patients with previous cervical spine surgery. A 66-year-old, otherwise healthy, woman who underwent C1/2 posterior surgical fusion for rotatory instability during adolescence presented to a chiropractor with a six-month history of progressive worsening of chronic neck pain and headaches despite acetaminophen, tramadol, and physical therapy. Upon examination, the chiropractor noted postural changes, limited cervical range of motion, and muscle hypertonicity. Computed tomography revealed a successful C1/2 fusion, and degenerative findings at C0/1, C2/3, C3/4, and C5/6, without cord compression. As the patient had no neurologic deficits or myelopathy and tolerated spinal mobilization well, the chiropractor applied cervical SMT, along with soft tissue manipulation, ultrasound therapy, mechanical traction, and thoracic SMT. The patient's pain was reduced to a mild level and the range of motion improved over three weeks of treatment. Benefits were maintained over a three-month follow-up as treatments were spaced apart. Despite the apparent success in the current case, evidence for manual therapies and SMT in patients with cervical spine surgery remains limited, and these therapies should be used with caution on an individual patient basis. Further research is needed to examine the safety of manual therapies and SMT in patients following cervical spine surgery and determine predictors of treatment response.

Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness.

BACKGROUND Vertebrobasilar insufficiency (VBI) is most often caused by vertebrobasilar atherosclerosis, often presenting with dizziness and occasionally neck pain. Little research or guidelines regarding management of neck pain in affected patients exists. CASE REPORT A 62-year-old male hypertensive smoker presented to a chiropractor with a 13-year history of insidious-onset neck pain, dizziness, and occipital headache with a Dizziness Handicap Inventory (DHI) of 52%. The patient had known VBI, caused by bilateral vertebral artery plaques, and cervical spondylosis, and was treated with multiple cardiovascular medications. The chiropractor referred patient to a neurosurgeon, who cleared him to receive manual therapies provided manual-thrust cervical spinal manipulative therapy (SMT) was not performed. The chiropractor administered thoracic SMT and cervicothoracic soft tissue manipulation. The neck pain and dizziness mostly resolved by 1 month. At 1-year follow-up, DHI was 0%; at 2 years it was 8%. A literature search revealed 4 cases in which a chiropractor used manual therapies for a patient with VBI. Including the present case, all patients had neck pain, 60% had dizziness, and all were treated with SMT either avoiding manual cervical manipulation altogether or modifying it to avoid or limit cervical rotation, yielding positive outcomes. CONCLUSIONS The present and previous cases provide limited evidence that some carefully considered chiropractic manual therapies can afford patients with VBI relief from concurrent neck pain and possibly dizziness. Given the paucity of research, cervical SMT cannot be recommended in such patients. These findings do not apply to vertebral artery dissection, for which SMT is an absolute contraindication.

Conservative management of pediatric temporomandibular disc displacement presenting as juvenile idiopathic arthritis: a case report.

There is limited research regarding management of temporomandibular disorders (TMD) in adolescents with imaging signs of juvenile idiopathic arthritis (JIA). An 11-year-old girl presented to a hospital-based chiropractor for evaluation of a 1.5-year history of unilateral temporomandibular joint (TMJ) pain and trismus. Previously, pediatric rheumatologists diagnosed JIA after contrast-enhanced magnetic resonance imaging revealed edema, effusion, and bilateral anterior disc displacement, and recommended methotrexate, corticosteroid injection, and arthrocentesis. The chiropractor questioned the JIA diagnosis, instead relating symptoms to a mechanical TMD/disc origin. Manual therapy, TMJ exercises, and acupuncture improved TMJ pain and opening. Invasive medical JIA interventions were avoided without long-term recurrence, further questioning the preceding JIA diagnosis. The success of this case suggests that stepped care, beginning with conservative treatment, has value for adolescents with TMD suspect for JIA. Integration of chiropractors and acupuncturists into healthcare institutions may facilitate this care model by affording nonpharmacologic interventions earlier in patient care.

Il existe peu de recherches sur la prise en charge des troubles temporo-mandibulaires (TTM) chez les adolescents présentant des signes d'imagerie de l'arthrite juvénile idiopathique (AJI). Une fillette de 11 ans s'est présentée chez un chiropraticien en milieu hospitalier pour l'évaluation d'un antécédent d'un an et demi de douleur unilatérale à l'articulation temporo-mandibulaire (ATM) et de trismus. Auparavant, les rhumatologues pédiatriques diagnostiquaient l'AJI une fois que l'imagerie par résonance magnétique avec contraste aurait révélé un œdème, un épanchement et un déplacement bilatéral du disque antérieur, et recommandaient le méthotrexate, l'injection de corticostéroïdes et l'arthrocentèse. Le chiropraticien a remis en question le diagnostic d'AJI, associant plutôt les symptômes à une origine mécanique du TTM/ disque. La thérapie manuelle, les exercices de l'ATM et l'acupuncture ont amélioré la douleur et l'ouverture de l'ATM. Les interventions médicales invasives d'AJI ont été évitées sans récidive à long terme, remettant davantage en question le diagnostic d'AJI précédent. Le succès de ce cas suggère que les soins par étapes, en commençant par un traitement conservateur, ont de la valeur pour les adolescents atteints de TTM supposés d'AJI. L'intégration des chiropraticiens et des acupuncteurs dans les établissements de santé peut faciliter ce modèle de soins en permettant des interventions non pharmacologiques plus tôt dans les soins aux patients.

Renal cell carcinoma in a 44-year-old man: an etiology for low back pain.

OBJECTIVE: The aim of this case study is to describe a patient with low back pain due to renal cell carcinoma (RCC). A brief review of RCC, including clinical presentation, diagnostic imaging, treatment, and outcomes, is discussed. CLINICAL FEATURES: A 44-year-old man presented to a chiropractic clinic with chronic low back pain. Lumbar spine radiographs and follow-up computed tomography scan revealed renal calcification, which was first thought to be calcified hematoma, but later, biopsy confirmed that it was RCC. INTERVENTION AND OUTCOME: A nephrectomy was performed. At 7-year follow-up, the patient is healthy. CONCLUSION: Renal cell carcinoma is not uncommon, and its varied clinical presentation may lead individuals to seek a variety of health care providers. Spine practitioners should be aware of the possibility of RCC in the clinical presentation of low back pain.

Use of percutaneous vertebroplasty for intractable back pain associated with compression fracture in an 80-year-old female.

OBJECTIVE: The aim of this study is to describe a patient with painful osteoporotic compression fracture and subsequent relief from percutaneous vertebroplasty (PVP). A brief review of vertebroplasty including indications, contraindications, and potential complications is discussed. CLINICAL FEATURES: An 80-year-old woman presented with severe low back pain and no history of trauma. Initial radiographs showed a typical benign, osteoporotic compression fracture of L1. INTERVENTION AND OUTCOME: Percutaneous vertebroplasty was performed because of severe intractable low back pain. The patient had an excellent response to PVP. Postoperative radiographs showed only slight central compression fracture of L1 with partial central filling of the vertebral body with cement, and generalized osteopenia. CONCLUSION: This article provides a case study and an overview of PVP. Percutaneous vertebroplasty may be a viable option for treatment of painful vertebral compression fractures if more conservative measures are unsuccessful.

Advances in MR imaging of vertebral collapse.

Vertebral collapse is a frequently encountered entity in clinical practice. While diagnosing acute, benign traumatic types is usually not complicated, difficulties arise in determining the etiology of vertebral collapse when there is no history of significant trauma, especially in older populations. Considering up to one-third of vertebral collapse in patients with a known primary malignancy are benign, the diagnosis becomes even more difficult when there is a history of malignancy. Additionally, because primary cancer patients may be immunocompromised, the possibility of infectious vertebral collapse should also be entertained. The purpose of this article is to review all recent magnetic resonance imaging aspects of differentiating osteoporotic, malignant, and infectious vertebral collapse.