The Amelioration of Symptoms in Cervical Spinal Stenosis with Spinal Cord Deformation Through Specific Chiropractic Manipulation: A Case Report with Long-term Follow-up
 
   

The Amelioration of Symptoms in Cervical
Spinal Stenosis with Spinal Cord Deformation
Through Specific Chiropractic Manipulation:
A Case Report with Long-term Follow-up

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:
   Frankp@chiro.org
 
   

FROM:   J Manipulative Physiol Ther 2004 (Jun);   27 (5):   e7 ~ FULL TEXT

Kukurin GW

Private practice of chiropractic neurology,
George W. Kukurin, DC, DACAN,
2415 Sarah Street,
Pittsburgh, PA 15203
dacan@alt-compmed.com


OBJECTIVE:   To describe the chiropractic management of a patient with paresthesia on the entire left side of her body and magnetic resonance imaging (MRI)-documented cervical spinal cord deformation secondary to cervical spinal stenosis.

CLINICAL FEATURES:   A 70-year-old special education teacher had neck pain, headaches, and burning paresthesia on the entire left side of her body. These symptoms developed within hours of being injured in a side-impact motor vehicle accident. Prior to her visit, she had been misdiagnosed with a cerebrovascular accident.

INTERVENTION AND OUTCOMES:   Additional diagnostic studies revealed that the patient was suffering from cervical spinal stenosis with spinal cord deformation. Two manipulative technique systems (Advanced Biostructural Therapy and Atlas Coccygeal Technique) unique to the chiropractic profession and based on the theory of relief of adverse mechanical neural tension were administered to the patient. This intervention provided complete relief of the patient's complaints. The patient remained symptom-free at long-term follow-up, 1 year postaccident.

CONCLUSION:   There is a paucity of published reports describing the treatment of cervical spinal stenosis through manipulative methods. Existing reports of the manipulative management of cervical spondylosis suggest that traditional manual therapy is ineffective or even contraindicated. This case reports the excellent short-term and long-term response of a 70-year-old patient with MRI-documented cervical spinal stenosis and spinal cord deformation to less traditional, uniquely chiropractic manipulative techniques. This appears to be the first case (reported in the indexed literature) that describes the successful amelioration of the symptoms of cervical spinal stenosis through chiropractic manipulation. More research into the less traditional chiropractic systems of spinal manipulation should be undertaken.


From the Full-Text Article:

Discussion

The exact mechanism by which the signs and symptoms in CSS are generated is controversial. The 2 most prominent theories are direct compression of the neural elements at the stenotic spinal level and tension within the neuroaxis transmitted from the spinal column to the neural tissues through various soft tissue supporting structures. [10] The clinical picture is further complicated because the neurological insult may be from direct pressure on the neural elements or produced indirectly through compression of vascular elements. [8] The emerging model is one of a multifactorial causation, with each patient having a unique combination of neural pressure and tension, as well as vascular compromise. The 2 manipulative procedures administered to this patient are based on theories derived from the known interrelationship between the bony spinal column (posture) and the response of the neural elements to these postures. Based on the MRI data of Muhle, [23] it does seem plausible that in at least some patients with CSS, an abnormal resting posture may increase compression of the neural elements. Unfortunately, without a posttreatment MRI in this case, it is impossible to determine if the chiropractic procedures employed actually reduced neural element impingement. Other explanations for the clinical recovery seen in this patient, such as effects of mechanoreceptor stimulation, are possible. Reflex pain inhibition following mechanoreceptor stimulation has been well documented. [25] However, unlike its known effects on pain modulation, it is unclear if mechanoreceptor stimulation can alter what appears to be, in this case, centrally generated paresthesia. Furthermore, it is doubtful that a short course of mechanoreceptor stimulation (if it can modulate paresthesia) could provide the long-lasting suppression of symptoms seen in this case. Spontaneous recovery is another possibility; however, even with surgical intervention, it appears that the long-term prognosis of patients with CSS is only modest. A large number of patients tend to deteriorate after an initial phase of improvement. [12, 14] However, a controlled trial with a larger number of patients would be needed to rule out spontaneous recovery. The growing availability of weight-bearing and dynamic MRI studies like the ones described by Muhle [23] may provide the technology needed to better understand the pathophysiology of CSS. These imaging techniques may also provide a valuable tool with which to assess various chiropractic techniques. Further study utilizing emerging imaging and other noninvasive technology may help to explain the clinical improvement frequently reported in chiropractic patients and help to identify the mechanisms responsible for this improvement.


Conclusion

Resolution of the signs and symptoms of cervical stenosis with MRI-documented spinal cord compression through chiropractic techniques is reported. This case suggests the need for more research into the less traditional chiropractic techniques. More research is needed to identify the exact mechanisms of neurological insult seen in cervical spinal stenosis. Better understanding of the pathophysiology of this condition may lead to novel conservative approaches to treatment.


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