Chiropractic & Pain Case Studies

Case 1

Spine Structures

  • Disc > Degeneration/ Herniation

  • Joints > Arthritis

  • Bone > Compression Fracture

  • Ligaments and Tendons > Sprain/ Strain

spinal nerve

Spine Structures

  • 44 year old male truck driver

  • Complaining of low back pain of long standing constant low grade daily pain with recent gradual worsening

  • Worse with sitting and bending

  • Better with heat

  • Previous treatments: Stretch, over the counter meds (NSAIDS, Tylenol)

  • Exam suggestive of diffuse low back pain, neurological exam intact, good range of motion

  • 8 session of adjustments 

  • Patient’s pain improved both in intensity, frequency and the area of pain was significantly reduced

  • Motion of the spine upon palpation normalized

  • However, patient continued to have pain in a focal area left low back


     

Back Pain

  • Affects 2/3 of adults

  • 2nd most common reason for physician visit

  • Most common reason for work disability

back pain
disc compression

Disk Degeneration

Athritis

Facet Joint Medial Branches

exam

Exam Under Fluoroscopy

pedicle

Case 1 Details

  • Patient underwent left sided L3/4 and L4/5 lumbar facet injections

  • Per patient request the procedure was done with local anesthesia only

Facet Joint Injection

lumbar spine
lumbar facet

Lumbar Facet Joint Injections

Case 1 Details

  • Immediate post op response 100% pain relief

  • 2 weeks later patient still has no back pain but continues to get adjustments

Medial Branch Block

medial branch block
spine
target

Lumbar Radiofrequency

Neurotomy (Rhizotomy)

nerve before procedure

Case 2

Case 2 Details

  • 34 year old male coming from ER with diagnosis of sciatica

  • Complaining of severe 8/10 VAS Low back right buttock and leg pain

  • Started 3 weeks prior after playing softball. He was then also involved in a MVA a week prior to visit, which worsened symptoms

  • Did complete exam. Disc Suspected

  • Gave patient choice of daily chiro visits or to see pain and begin chiro once severe pain has decreased.

  • He chose pain.
     

  • Normal neurological exam

  • Positive straight leg raise test at 15 degrees on the right side.

  • Started on NSAIDs, muscle relaxant and low dose narcotics

  • Ordered MRI
     

nsaid
disc suspended
sever low back
extrusion

  • L3/4 Right paracentral disc protrusion/extrusion as well as annular tear

  • L4/5 Central to right paracentral disc extrusion as well as annular tear

Interlaminar Epidural Steroid Injection

Transforaminal Epidural Steroid Injection

  • Patient reported 70% to 80% relief of pain from his first transforaminal epidural steroid injection; but continues to have tingling in the foot. 

  • He recently received his second epidural steroid injection.

  • Based on his  response to 1st injection, likely wouldn't need a spine surgeon involvement.

invasive

New Approach: Ultra Minimally Invasive

Disc Herniations Unresponsive to Injections

The size of a #2 pencil