Missed sacral fracture before chiropractic adjustment.

OBJECTIVE: Reports of complications after chiropractic adjustments were administered to the lumbar spine and/or pelvis are rare. This case report provides the events associated with a sacral fracture that was not identified before a side-posture sacroiliac adjustment. CLINICAL FEATURES: The patient suffered from blunt, low back trauma as a result of a fall. Clinical evaluation indicated fixation dysfunction at the left sacroiliac articulation, with minimal edema/tenderness at the inferior portion of the left sacroiliac joint. Initial radiological evaluation failed to disclose the zone 2 sacral fracture because of an underexposed radiograph; thus, the patient was given a diagnosis of a sacroiliac sprain subluxation. INTERVENTION AND OUTCOME: A specific contact sacroiliac adjustment that uses the innominate as the short lever arm was administered to the patient in the side-posture position. Two adjustments were administered over 2 days. The patient developed sciatic pain after the second adjustment and subsequently referred herself to a medical orthopedist. Additional plain films were obtained, and a diagnosis of a zone 2 sacral fracture was made. The patient was prescribed bed rest; at 6 wk, her symptoms resolved and she returned to normal activity levels. CONCLUSION: Fractures of the spine and pelvis need to be considered in a patient who suffers blunt trauma. An adequate radiographic examination is necessary to make the appropriate diagnosis. Failure to diagnose the fracture may lead to complications, because the adjustment is not administered with regard to the biomechanics of the trauma or the actual clinical entity under scrutiny. This case study represents the first report of a complication after a sacroiliac adjustment in a patient who had a zone 2 sacral fracture that was missed in the diagnosis.

The reliability of patient positioning for evaluating static radiologic parameters of the human pelvis.

OBJECTIVE: To determine the reproducibility of patient positioning on radiographically evaluated static configurations of the human pelvis. DESIGN: Repeat anteroposterior radiography of the human pelvis was performed in vivo. Comparative examinations were performed after 1 hr in one subject pool. A second sample underwent repeat examination after a mean of 18 days. SETTING: Outpatient private practice chiropractic clinic. SUBJECTS: Thirty-seven relatively asymptomatic subjects participated in the experiment. MAIN OUTCOME MEASURES: Millimetric evaluations were made for leg length inequality, right/left sacral discrepancies and right/left innominate differences. The null hypothesis was that the difference of the measurements from the two radiographs would be equal to zero. A paired t-test was used to analyze if there were any significant differences. The mean measured difference in millimeters and correlation coefficients were also determined for each variable. RESULTS: Individual variations for several roentgenometric parameters, including leg length inequality and pelvic torsion, did not reach statistical significance (p > .05) although minor millimetric discrepancies were recorded. Correlation coefficients, in most cases, were relatively high. CONCLUSION: A subject can be reliably positioned for repeat anteroposterior pelvic radiography for both 1 hr and 18-day intervals. The methodology described has applicability to full spine radiography when roentgenometric parameters of the pelvis are scrutinized.

The interexaminer reliability of a galvanic skin response instrument.

OBJECTIVE: To determine the interexaminer reliability of a protocol of use of a galvanic skin resistance device for detection of low resistance areas along the spinal column, in relatively pain-free subjects. DESIGN: A blinded investigation of concordance of skin resistance examination findings over the spinal column using two clinicians experienced in the use of the instrument. SETTING: A private practice chiropractic outpatient clinic. PATIENTS: Sixty-four male and female chiropractic college students (mean age: 35 yr). The Visual Analog Pain Scale indicated a mean response of 7.6 mm on a 100-mm range. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Concordance of examiners evaluated with the kappa statistic. RESULTS: The results indicated modest levels of concordance for the first study sample (n = 46). The average kappa was 0.37. The second group assessed (n = 18) also demonstrated only modest levels of interexaminer concordance. The average kappa value for this sample was 0.36. CONCLUSION: The use of the Electrical Conductor Scanner instrument for evaluating putative spinal pathology through manifestations in skin resistance in relatively asymptomatic subjects is not supported by the results of this experiment. The unevenness of data generated from this experiment in certain spinal regions necessitates further investigation prior to making any strong conclusions regarding the usefulness of this instrument in the clinical setting.