RESUMEN
OBJECTIVE: To discuss the combined use of selective epidural steroid injection (ESI) and spinal manipulative therapy (SMT) in treating recalcitrant lumbar radiculopathy. CLINICAL FEATURES: In a first case, a patient suffered from numbness and pain in an S1 dermatome distribution 6 months after undergoing lumbar discectomy. Clinical correlation with advanced imaging led to the diagnosis of L5 intervertebral disc (IVD) syndrome with peridural scar formation. In a second case, a patient suffered from low-back and right-leg pain of 9 months' duration. Various forms of conservative treatment were not effective. A diagnosis of L4 IVD syndrome with radiculopathy was made. INTERVENTION AND OUTCOME: The first patient received conventional treatments, including physical therapy, SMT, fluoroscopically guided ESI and oral medications, with consistent but short-lived response. A team consisting of an anesthesiologist (dedicated spinal injectionist) and chiropractor performed manipulation under epidural anesthesia (MUEA) with corticosteroid injection. Follow-up at 60 days showed marked improvement in visual analogue scale, pain drawing and Oswestry pain and disability index. The second patient received all of the same conventional care except ESI before the combined procedure. The patient underwent MUEA, followed up with eight sessions of stretching and manipulation over the ensuing 3 wk. At 45 days after the combined procedure, the patient had a negative SLR (previously positive at 70 degrees), no leg pain and a marked reduction in back pain. CONCLUSION: This article discusses an integrated procedure that combines two standard treatments that may act synergistically. Our positive results are consistent with other reports, both published and anecdotal. The technique of MUEA warrants further investigation by the health care industry.
Asunto(s)
Corticoesteroides/administración & dosificación , Anestesia Epidural , Quiropráctica , Dolor de la Región Lumbar/terapia , Vértebras Lumbares , Radiculopatía/terapia , Adulto , Humanos , Inyecciones Epidurales , MasculinoRESUMEN
OBJECTIVE: To determine the prevalence of the postsurgical back cases in established chiropractic offices. DESIGN: A random sample was obtained from each practice for the 30-d duration of the study. Consecutive patients were identified as being postspinal surgical or not. Those individuals who were postsurgical had other demographic information elicited from their cases. SETTING: Each chiropractic office was a primary care facility open to the general community. PATIENTS: Nonsolicited, routine daily flow patients. Each consecutive patient was counted as a participant. A total of 1,939 patients were involved in this study. MAIN OUTCOME AND RESULTS: Sixty-eight patients (3.75%, P = < 0.10) had undergone at least one spinal surgery. Thirty-two were male and 36 were female. Ten patients had previously experienced cervical surgery, while four had thoracic surgery; 55 individuals had previous lumbar surgery. Four patients reported two prior lumbar surgeries, one had three lumbar surgeries, and one had two lumbar and one cervical surgery. The average age of the postspinal surgery patient was 52 yr old (range 26-86 yr). Average time since surgery was 14.5 yr (range 0.5-41 yr). Thirteen individuals stated their condition had been made worse as a result of the surgery. CONCLUSION: The study demonstrated that the chiropractic profession is involved in treating a significant number of postsurgical back patients. The prevalence of these types of surgeries in the primary care chiropractic practice was found to be above the anticipated level in the general public.
Asunto(s)
Quiropráctica/estadística & datos numéricos , Columna Vertebral/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
OBJECTIVE: To present a case of myositis ossificans traumatica (MOT) in a hockey player. Serial X-ray studies allow the reader an opportunity to observe MOT in its earliest through fulminated stages. CLINICAL FEATURES: A 20-yr-old hockey player was subjected to an acute blow to the lateral thigh. Copious amounts of swelling soon developed. The patient was unable to skate. X-rays were initially performed 4 hr after the injury and demonstrated a hugh mass developing in the thigh at that time. INTERVENTION AND OUTCOME: The player was inappropriately treated with deep tissue massage and heat at the time of injury. It is believed that this led to the fulmination and advanced degree of MOT development. Immobilization allowed for resorption of the calcific density of the ossified structure. CONCLUSION: Proper care of acute trauma is essential in disorders of this nature. Ice, immobility and recognition of when a possible MOT lesion is developing is essential when dealing with contact sports.
Asunto(s)
Hockey/lesiones , Miositis Osificante/diagnóstico por imagen , Miositis Osificante/fisiopatología , Adulto , Humanos , Masculino , Miositis Osificante/terapia , Pronóstico , Radiografía , Fútbol/lesiones , Medicina DeportivaRESUMEN
This study compares the findings of plain film X-ray and computed CT examination in the diagnosis of facet orientation and the presence of tropism. Twenty consecutive patients having lumbar disc disease with sciatica were studied utilizing plain X-ray as well as CT scanning. A chiropractic radiologist read the films to determine if facet facings were sagittally, semi-sagittally or coronally oriented on both CT and plain X-ray study. CT was accepted as the most accurate method to determine the true facet orientation, and plain X-ray interpretation of facet orientation was compared to the CT reading. There was a statistically significant relationship in diagnosing tropism between plain film X-ray and CT readings, with a predictive accuracy that ranged from 58-84% across the three segmental levels. However, the exact concordance of plain film X-ray and CT readings for right and left facet facings was very low. This raises the question of how the profession defines diagnostic accuracy.
Asunto(s)
Dolor de Espalda/diagnóstico por imagen , Vértebras Lumbares/anomalías , Radiografía/normas , Tomografía Computarizada por Rayos X/normas , Dolor de Espalda/epidemiología , Dolor de Espalda/etiología , Estudios de Evaluación como Asunto , Humanos , Vértebras Lumbares/diagnóstico por imagen , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Brucellosis infection in humans is very rare in the United States. Occasional cases are identified primarily in individuals who have been exposed to an animal's raw dairy products. Presented is a rare case of human brucellosis involving the cervical spine. Of interest is how the case unfolds, reminding the practitioner of the need for thorough clinical practice. A review of clinical features and findings is offered.
Asunto(s)
Brucelosis/diagnóstico , Vértebras Cervicales , Enfermedades de la Columna Vertebral/diagnóstico , Articulación Atlantoaxoidea/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Quiropráctica , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
The incidence of a C7 spondylolisthesis has never been reported, and this paper shows the presence of C7 and L4 degenerative spondylolisthesis in a 66-yr-old female. No report of this combined problem has been reported. The clinical findings of the patient are given as well as treatment protocol.
Asunto(s)
Vértebras Cervicales , Vértebras Lumbares , Espondilolistesis/patología , Anciano , Quiropráctica , Femenino , Marcha , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/complicaciones , Radiografía , Factores Sexuales , Espondilolistesis/diagnóstico por imagen , Espondilolistesis/epidemiología , Espondilolistesis/fisiopatología , Espondilolistesis/terapiaRESUMEN
A literature review of the incidence and effects of manipulation on intervertebral disc protrusion is given. A case presented had a 14% reduction of the disc bulge following manipulative care with complete relief of sciatic and low back pain. A system to evaluate the size of disc herniation in computed tomography scans performed before and after manipulative treatment of disc protrusions is offered. Stenosis, with the critical compounded factors of vertebral canal size, dural sac cross-sectional area and soft tissue stenosis in protrusion of the ligamentum flavum and disc, as well as degenerative facet joint changes, is discussed to illustrate the complexity surrounding nerve root compression etiology. Understanding this integration of causative factors can help to explain low back symptoms and outline effective treatment plans.
Asunto(s)
Quiropráctica , Desplazamiento del Disco Intervertebral/terapia , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Visual leg length insufficiency detection and correction is compared with established radiographic procedures on 41 consecutive patients presenting to a chiropractic clinic with low back pain. It is commonly accepted that the most accurate procedure of short leg demonstration is the standing X ray. Visual correction, as described by Rene Cailliet, uses three anatomical points of reference: a) iliac crest levelness, b) vertical appraisal of the spine from the sacral base (the spine should be perpendicular to the sacral base) and c) levelness of the posterosuperior iliac spine (PSIS) dimples. Lifts of varying thickness were placed under the foot of the short leg in both leg length corrective procedures. This study found that the visual method of measurement did not differ significantly from the X-ray method of measurement for leg length insufficiency. Further, it was found that when comparing those in which the visual measure was less than the X-ray measure and those in which the visual measure was greater, there was a significant relationship between visual and X-ray measures. Eta (eta 2) demonstrates that there is a very strong relationship between visual and X-ray methods of measurement. A review of the literature is presented regarding the correlation of leg length insufficiency and musculoskeletal disorders, as well as the discrepancy required to alter biomechanical properties of the trunk and lower extremity.
Asunto(s)
Diferencia de Longitud de las Piernas/diagnóstico , Análisis de Varianza , Alargamiento Óseo , Quiropráctica , Humanos , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Diferencia de Longitud de las Piernas/terapia , RadiografíaRESUMEN
Presented is a case report of chiropractic manipulative therapy and transcutaneous neuromuscular stimulation utilized in the treatment of progressive adolescent idiopathic scoliosis. The curvature was shown to be progressing at the rate of 1.0 degrees/month for the 9 previous months. The patient's curvature was successfully stopped at 27 degrees and reversed to 17 degrees in the first 3 months of care. After 9 months of nighttime stimulation, the curvature was recorded at 23 degrees. Also included is a review of conservative scoliotic care and the effects of physical forces on glycoprotein structures.