RESUMEN

OBJECTIVE: Evaluate chiropractic care including flexion distraction spinal manipulation for improving function, symptoms and performance-based mobility in patients with lumbar spinal stenosis (LSS) using a pretest-posttest design. METHODS: Data were collected at baseline, midpoint and final visits prior to care on each visit. Objective data included Timed Up and Go, Five Times Sit to Stand, and balance (force plate). An additional balance assessment was also conducted after care on the baseline visit. Subjective data included: Activities-Specific Balance Confidence Scale, Zurich Claudication Questionnaire, and pain ratings. Balance data were securely transferred via iDrive; the others were collected via REDCap. RESULTS: Twelve patients (mean age = 83.5 years ± 5.71) completed the average midpoint visit at 9 visits and the final visit at 13.7 visits. Timed Up and Go and Five Times Sit to Stand Test decreased by 5.2 and 6.7 s at midpoint and 5.4 and 5.7 s at the final visit, respectively compared to the baseline visit (p < 0.05). Baseline visit pre-post reductions were found in anterior-posterior sample entropy and mean frequency of postural sway (p < 0.05). No balance change was found between baseline and mid or final visits. All subjective measures had statistically and clinically meaningful improvement. CONCLUSION: Significant improvement in objective and subjective outcomes were found after a pragmatic course of care including spinal manipulation in LSS patients.

Asunto(s)

Manipulación Espinal , Estenosis Espinal , Anciano de 80 o más Años , Humanos , Vértebras Lumbares , Proyectos Piloto , Estudios Prospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: This case reports discusses the case of a 43-year-old man with concurrent cervical spine radiculopathy and herpes zoster shingles infection. CLINICAL FEATURES: A 43-year-old man with left sided C6 radiculopathy was seen and treated for the clinical diagnosis of C5-C6 disc herniation. Ten days before seeking care he had received influenza and pneumococcal vaccinations. A week after vaccination, he noticed tingling, aching, and fatigue in his left arm. A week later, a rash appeared on his left arm. This was diagnosed via Teladoc as shingles; ibuprofen was prescribed, as too much time had elapsed for antiviral medication. INTERVENTION AND OUTCOME: Chiropractic spinal manipulation using Cox distraction protocols for a C5-C6 disc herniation was given 5 times over a time period of 5 weeks. This treatment resolved the patient's left arm pain, provided 50% relief for his neck pain, and decreased his left arm rash. Four spinal manipulations were given over the next 12-week period, resulting in 80% reduced neck pain, complete resolution of left arm pain, and faint herpetic rash. The patient stated that he felt he had returned to his level of health before the incident. CONCLUSION: Concurrent upper extremity radicular pain accompanied by herpes zoster cutaneous rash is described. Chiropractic spinal manipulation using Cox spinal distraction protocols saw resolution of the patient's complaints. Considered to be an uncommon dual occurrence, radiculopathy and herpes zoster infection deserve clinical discussion and evaluation of treatment protocols.

RESUMEN

PURPOSE: The purpose of this case series is to report on changes in pain levels experienced by 69 postsurgical continued pain patients who received Cox Technic Flexion Distraction (CTFD). METHODS: Fifteen doctors of chiropractic collected retrospective data from the records of the postsurgical continued pain patients seen in their clinic from February to July 2012 who were treated with CTFD, which is a type of chiropractic distraction spinal manipulation. Informed consent was obtained from all patients who met the inclusion criteria for this study. Data recorded included subjective patient pain levels at the end of the treatments provided and at 24 months following the last treatment. RESULTS: Fifty-four (81%) of the patients showed greater than 50% reduction in pain levels at the end of the last treatment, and 13 (19%) showed less than 50% improvement of pain levels at the end of active care (mean, 49 days and 11 treatments). At 24-month follow-up, of 56 patients available, 44 (78.6%) had continued pain relief of greater than 50% and 10 (18%) reported 50% or less relief. The mean percentage of relief at the end of active care was 71.6 (SD, 23.2) and at 24 months was 70 (SD, 25). At 24 months after active care, 24 patients (43%) had not sought further care, and 32 required further treatment consisting of chiropractic manipulation for 17 (53%), physical therapy, exercise, injections, and medication for 9 (28%), and further surgery for 5 (16%). CONCLUSION: Greater than 50% pain relief following CTFD chiropractic distraction spinal manipulation was seen in 81% of postsurgical patients receiving a mean of 11 visits over a 49-day period of active care.