Chiropractic & Pain Case Studies
Case 1
Spine Structures
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Disc > Degeneration/ Herniation
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Joints > Arthritis
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Bone > Compression Fracture
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Ligaments and Tendons > Sprain/ Strain
Spine Structures
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44 year old male truck driver
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Complaining of low back pain of long standing constant low grade daily pain with recent gradual worsening
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Worse with sitting and bending
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Better with heat
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Previous treatments: Stretch, over the counter meds (NSAIDS, Tylenol)
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Exam suggestive of diffuse low back pain, neurological exam intact, good range of motion
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8 session of adjustments
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Patient’s pain improved both in intensity, frequency and the area of pain was significantly reduced
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Motion of the spine upon palpation normalized
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However, patient continued to have pain in a focal area left low back
Back Pain
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Affects 2/3 of adults
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2nd most common reason for physician visit
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Most common reason for work disability
Disk Degeneration
Athritis
Facet Joint Medial Branches
Exam Under Fluoroscopy
Case 1 Details
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Patient underwent left sided L3/4 and L4/5 lumbar facet injections
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Per patient request the procedure was done with local anesthesia only
Facet Joint Injection
Lumbar Facet Joint Injections
Case 1 Details
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Immediate post op response 100% pain relief
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2 weeks later patient still has no back pain but continues to get adjustments
Medial Branch Block
Lumbar Radiofrequency
Neurotomy (Rhizotomy)
Case 2
Case 2 Details
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34 year old male coming from ER with diagnosis of sciatica
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Complaining of severe 8/10 VAS Low back right buttock and leg pain
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Started 3 weeks prior after playing softball. He was then also involved in a MVA a week prior to visit, which worsened symptoms
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Did complete exam. Disc Suspected
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Gave patient choice of daily chiro visits or to see pain and begin chiro once severe pain has decreased.
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He chose pain.
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Normal neurological exam
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Positive straight leg raise test at 15 degrees on the right side.
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Started on NSAIDs, muscle relaxant and low dose narcotics
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Ordered MRI
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L3/4 Right paracentral disc protrusion/extrusion as well as annular tear
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L4/5 Central to right paracentral disc extrusion as well as annular tear
Interlaminar Epidural Steroid Injection
Transforaminal Epidural Steroid Injection
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Patient reported 70% to 80% relief of pain from his first transforaminal epidural steroid injection; but continues to have tingling in the foot.
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He recently received his second epidural steroid injection.
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Based on his response to 1st injection, likely wouldn't need a spine surgeon involvement.
New Approach: Ultra Minimally Invasive
Disc Herniations Unresponsive to Injections
The size of a #2 pencil