Chiropractic & Pain Case Studies

Case 1

Case 1 Details

• 42 year old psychologist

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• Started Chiropractic care 03/03/16

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• Complaining of on going neck, upper thoracic pain of about a month duration

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• Pain increased by sitting and computer use

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• Initial Pain resolved by 03/28/16 after 6 visits and then started monthly treatments with good results and minimal reported pain

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• MRI of the cervical spine was ordered

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• On 10/21/2016 (7 months after first visit) patient reported new increased pain in the cervical spine.

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• Pain was reported as severe, shooting, sharp and stabbing rated 9/10

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• Reported recent cold with lots of coughing and sneezing a week prior

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• Patient further reported new pain shooting down to the left shoulder and left arm

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• Worse with sitting for long period of time

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• Better with Ice, laying down

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• Prescribed muscle relaxant (Flexeril) 10 mg po qhs and hydrocodone 5-325 mg po tid prn.

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• Second Cervical Epidural Steroid Injection 12/13/2016 combined with continued chiropractic therapy > 99% relief of neck and left arm pain

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• Emphasized importance of ongoing adjustments and physical therapy

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• No follow up with Pain needed

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• Keeps seeing Dr. Stephens

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• Happy camper

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• No PCP > Spine Surgeon > Surgery > More problems down the road

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• No High Dose Narcotics > Dependence > Addiction > Impact of life/ Job

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• What if Patient’s left arm pain improved but she continued to have neck Pain?
   

Cervical Facet Radiofrequency Neurotomy

Spine Structures​

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Case 2

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• 57 year old Male originally from NJ currently resident of McKinney

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• 5 year history of Low back, Left buttock and occasional Left leg pain

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• Patient had tried:

  • Chiropractic care on and off for about 5 years > Short term relief​

  • NSAIDs, Tylenol, Low Dose Narcotics > Minimal Relief

  • Massage therapy >Minimal Relief

  • Physical Therapy > Minimal Relief

  • Series of three Epidural Steroid Injection by another provider in Allen > Minimal Relief

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• ​Patient saw a spine surgeon in Allen who did not recommend surgery as the MRI “did not look that bad”
   

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• First visit 10/28/2016

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• Normal neurological exam

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

Interlaminar Epidural Steroid Injection

Transforaminal Epidural Steroid Injection

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• Patient reported 70% relief only for a day relief of pain from Left L5-S1 transforaminal epidural steroid injection 11/01/2016

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• He reported No improvement upon follow up on 11/17/2016

Disc Herniations Unresponsive to Injections

Old Approach: Open Laminectomy & Discectomy

New Approach: Minimally Invasive

New Approach: Ultra Minimally Invasive

Advantages

• Less

  • Trauma to muscles, ligaments

  • Bone resection>Iatrogenic Instability>Need for instrumented fusion

  • Epidural fibrosis

  • Bleeding

  • Faster recovery/ Less Postop Pain

  • Doesn’t “burn any bridges” for future revisio

  • Could be done without GA in high risk patients

Instrumentation for Stability

Laminectomy > Instability

Adjacent level disease

Later down the Road...

New Approach: Ultra Minimally Invasive

Thermal Annuloplasty Endoscopic 

Case 2 Conclusion

• Patient underwent Left L5-S1 endoscopic discectomy and annuloplasty on 11/29/2016

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• Upon follow up on 01/06/2017 patient reported 70% relief of his pain

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• “The best he has felt in 5 years”

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• Patient was released back to follow up with his Chiropractor to continue adjustments and therapy

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• Would like us to now focus on his shoulder

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• What if he wants the remaining back pain gone?