Chiropractic & Pain Case Studies
Case 1
Case 1 Details
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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
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:
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Chiropractic care on and off for about 5 years > Short term relief
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NSAIDs, Tylenol, Low Dose Narcotics > Minimal Relief
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Massage therapy >Minimal Relief
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Physical Therapy > Minimal Relief
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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
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Less
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Trauma to muscles, ligaments
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Bone resection>Iatrogenic Instability>Need for instrumented fusion
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Epidural fibrosis
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Bleeding
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Faster recovery/ Less Postop Pain
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Doesn’t “burn any bridges” for future revisio
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Could be done without GA in high risk patients
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Instrumentation for Stability
Laminectomy > Instability
Adjacent level disease

Later down the Road...

New Approach: Ultra Minimally Invasive

Thermal Annuloplasty Endoscopic
Case 2 Conclusion
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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?