Colorectal Cancer Presenting as Sacral Pain at a Chiropractic Clinic.

This case report describes a diagnosis of spinal pain secondary to metastatic colon cancer, highlighting the need for close monitoring and an interdisciplinary approach for this cohort. An 82-year-old female presented with acute exacerbation of chronic low back pain with a rating of 7/10. She had a history of stage III colon cancer diagnosed 17 years previously and was currently in remission. Red flags included worsening pain after four days of oral analgesics and a history of cancer. Imaging revealed an osteolytic L5 vertebral lesion with endplate disruption, consistent with metastasis. She was urgently referred to an oncologist who ordered chemotherapy and radiotherapy. The metastatic spread of malignancy to the spine can manifest as new or progressive back pain and requires prompt diagnosis and management. Magnetic resonance imaging is recommended for the detection of osseous lesions and spinal cord compression. The case report serves as an educational tool for chiropractors in recognizing and managing spinal metastasis. By sharing this case report, healthcare professionals can learn from the experiences and challenges faced during the patient's care and apply that knowledge to their practice.

Undiagnosed Osteoporotic Vertebral Fractures in an Octogenarian During the Coronavirus Disease Pandemic.

Osteoporotic vertebral fractures are frequently misdiagnosed or under-recognized in the older population, leading to disease progression and reduced quality of life. This case of an 87-year-old woman with acute back pain highlights the importance of early diagnosis and management of fragility fractures. During the coronavirus disease (COVID-19) pandemic, patients with a history of well-managed osteoporosis experienced worsening symptoms of vertebral collapse due to activity limitations and prolonged immobilization. The initial diagnosis of spinal stenosis delayed appropriate treatment for four months. Serial magnetic resonance imaging revealed compression fractures at L1 and L3, and a dual-energy x-ray absorptiometry scan showed osteoporosis with a T-score of -3.2. Pharmacological therapy, including bisphosphonates, was initiated. A comprehensive rehabilitation program with a multidisciplinary approach, with bracing, and lifestyle changes helped stabilize the spine, reduce pain, and maximized function. Her condition improved with close monitoring and guidance during home exercises. This case exemplifies the necessity of a precise and timely diagnosis of osteoporotic vertebral fractures to initiate management and mitigate disease progression.

Thyroid Cancer Presenting as Neck Pain at a Chiropractic Clinic.

We report an unusual case of metastatic papillary thyroid carcinoma presenting with progressive neck pain in a 58-year-old female with known bilateral thyroid nodules. Despite initial benign ultrasonographic findings and trials of conservative therapy for over 2 months, the patient's anterior neck pain and unremitting symptoms prompted concern regarding an underlying orthopedic condition. She sought chiropractic consultation, and MRI revealed pathologic vertebral fractures. Biopsy of the thyroid and vertebral bone lesions demonstrated metastatic thyroid carcinoma. The patient was diagnosed with papillary thyroid cancer. The early detection of metastatic disease is critical for optimizing oncological treatment and outcomes. This case highlights the importance of close follow-up when the initial workup or management fails, consideration of sinister pathologies in high-risk patients, and a multidisciplinary approach to complex conditions. It provides an important reminder not to attribute unresolved symptoms to benign causes without serial re-evaluation, especially in patients with known risks, such as thyroid disease. A high index of suspicion and openness to atypical disease presentations is fundamental to avoid missed opportunities for diagnosis and prompt treatment.

Pediatric Text Neck Syndrome.

Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.

Sacral Chordoma Presenting as Back Pain in the Chiropractic Clinic: A Case Report.

Cases of lumbar and gluteal pain are commonly encountered in chiropractic clinics, with a broad differential diagnosis primarily centered on musculoskeletal conditions. This report presents the second documented case of sacral chordoma diagnosed at a chiropractic clinic and emphasizes the importance of considering alternative diagnoses and interdisciplinary collaboration in patient care. A 42-year-old man presented to a chiropractic clinic with complaints of lumbar and gluteal pain. The initial conservative management based on a presumptive musculoskeletal diagnosis was ineffective. Suspicion of an alternative etiology prompted a referral for imaging, which revealed a sacral chordoma. An interdisciplinary collaboration involving orthopedic surgeons, oncologists, radiologists, and other healthcare professionals was initiated to optimize the treatment outcomes of this rare and aggressive tumor. This case report underscores the importance of maintaining a high index of suspicion in cases of musculoskeletal presentations in chiropractic clinics and the critical role of advanced imaging in establishing a definitive diagnosis. Interdisciplinary collaboration is essential for managing complex conditions such as sacral chordomas, ensuring the delivery of the highest quality of care, and optimizing patient outcomes. Chiropractors play a crucial role in identifying, referring, and contributing to the management of patients with complex presentations as part of a comprehensive multidisciplinary treatment plan.

Neck pain and Headache Complicated by Persistent Syringomyelia After Foramen Magnum Decompression for Chiari I Malformation: Improvement with Multimodal Chiropractic Therapies.

BACKGROUND Patients with Arnold-Chiari Malformation I (CM-I) treated with foramen magnum decompression (FMD) can have ongoing neck pain, headaches, and other symptoms complicated by persistent syringomyelia, yet there is little research regarding treatment of these symptoms. CASE REPORT A 62-year-old woman with a history of residual syringomyelia following FMD and ventriculoperitoneal shunt for CM-I presented to a chiropractor with progressively worsening neck pain, occipital headache, upper extremity numbness and weakness, and gait abnormality, with a World Health Organization Quality of Life score (WHO-QOL) of 52%. Symptoms were improved by FMD 16 years prior, then progressively worsened, and had resisted other forms of treatment, including exercises, acupuncture, and medications. Examination by the chiropractor revealed upper extremity neurologic deficits, including grip strength. The chiropractor ordered whole spine magnetic resonance imaging, which demonstrated a persistent cervico-thoracic syrinx and findings of cervical spondylosis, and treated the patient using a multimodal approach, with gentle cervical spine mobilization, soft tissue manipulation, and core and finger muscle rehabilitative exercises. The patient responded positively, and at the 6-month follow-up her WHO-QOL score was 80%, her grip strength and forward head position had improved, and she was now able to eat using chopsticks. CONCLUSIONS This case highlights a patient with neck pain, headaches, and persistent syringomyelia after FMD for CM-I who improved following multimodal chiropractic and rehabilitative therapies. Given the limited, low-level evidence for these interventions in patients with persistent symptoms and syringomyelia after FMD, these therapies cannot be broadly recommended, yet could be considered on a case-by-case basis.