Spinal gout diagnosis in chiropractic practice: narrative review.

Objective: To review and summarize the recent literature, increase awareness and provide guidance for chiropractic physicians regarding the diagnosis of spinal gout. Methods: A search of PubMed was undertaken for recent case reports, reviews and trials relating to spinal gout. Results: Our analysis of 38 cases of spinal gout revealed that 94% of spinal gout patients presented with back or neck pain, 86% displayed neurological symptoms, 72% had a history of gout, and 80% had raised serum uric acid levels. Seventy-six percent of cases proceeded to surgery. A combination of clinical findings, laboratory tests and appropriate utilization of Dual Energy Computed Tomography (DECT) has the potential to improve early diagnosis. Conclusion: Gout is an uncommon cause of spine pain; however, it must be considered in the differential diagnosis as outlined in this paper. Increased awareness of the signs of spinal gout and earlier detection and treatment has the potential to improve the quality of life of patients and reduce the need for surgery.

Objectif: Examiner et résumer la littérature récente, sensibiliser les médecins chiropraticiens et les guider dans le diagnostic de la goutte spinale. Méthodes: Une recherche a été entreprise dans PubMed pour trouver des rapports de cas, des études et des essais récents concernant la goutte spinale. Résultats: Notre analyse de 38 cas de goutte spinale a révélé que 94 % des patients souffrant de goutte spinale présentaient des douleurs dorsales ou cervicales, 86 % des symptômes neurologiques, 72 % des antécédents de goutte et 80 % une élévation du taux d'acide urique sérique. Soixante-seize pour cent des cas ont donné lieu à une intervention chirurgicale. La combinaison des résultats cliniques, des tests de laboratoire et de l'utilisation appropriée de la tomographie informatisée à double énergie (DECT) peut améliorer les chances d'un diagnostic précoce. Conclusion: La goutte est une cause peu fréquente de douleur vertébrale, mais elle doit être prise en compte dans le diagnostic différentiel, comme indiqué dans le présent document. Une meilleure connaissance des signes de la goutte spinale et une détection et un traitement plus précoces pourraient améliorer la qualité de vie des patients et réduire la nécessité d'une intervention chirurgicale.

In vivo measurement of intradiscal pressure changes related to thrust and non-thrust spinal manipulation in an animal model: a pilot study.

BACKGROUND: The intervertebral disc is a known back pain generator and is frequently the focus of spinal manipulative therapy evaluation and treatment. The majority of our current knowledge regarding intradiscal pressure (IDP) changes related to spinal manual therapy involves cadaveric studies with their inherent limitations. Additional in vivo animal models are needed to investigate intervertebral disc physiological and molecular mechanisms related to spinal manipulation and spinal mobilization treatment for low back disorders. METHODS: Miniature pressure catheters (Millar SPR-1000) were inserted into either the L4-L5 or L5-L6 intervertebral disc of 3 deeply anesthetized adult cats (Oct 2012-May 2013). Changes in IDP were recorded during delivery of instrument-assisted spinal manipulation (Activator V® and Pulstar®) and motorized spinal flexion with/without manual spinous process contact. RESULTS: Motorized flexion of 30° without spinous contact decreased IDP of the L4-L5 disc by ~ 2.9 kPa, while physical contact of the L4 spinous process decreased IDP an additional ~ 1.4 kPa. Motorized flexion of 25° with L5 physical contact in a separate animal decreased IDP of the L5-L6 disc by ~ 1.0 kPa. Pulstar® impulses (setting 1-3) increased IDP of L4-L5 and L5-L6 intervertebral discs by ~ 2.5 to 3.0 kPa. Activator V® (setting 1-4) impulses increased L4-L5 IDP to a similar degree. Net changes in IDP amplitudes remained fairly consistent across settings on both devices regardless of device setting suggesting that viscoelastic properties of in vivo spinal tissues greatly dampen superficially applied manipulative forces prior to reaching deep back structures such as the intervertebral disc. CONCLUSIONS: This study marks the first time that feline in vivo changes in IDP have been reported using clinically available instrument-assisted spinal manipulation devices and/or spinal mobilization procedures. The results of this pilot study indicate that a feline model can be used to investigate IDP changes related to spinal manual therapy mechanisms as well as the diminution of these spinal manipulative forces due to viscoelastic properties of the surrounding spinal tissues. Additional investigation of IDP changes is warranted in this and/or other in vivo animal models to provide better insights into the physiological effects and mechanisms of spinal manual therapy at the intervertebral disc level.

Cervical Radiculopathy Associated With Shingles Herpes Zoster Infection.

OBJECTIVE: This case reports discusses the case of a 43-year-old man with concurrent cervical spine radiculopathy and herpes zoster shingles infection. CLINICAL FEATURES: A 43-year-old man with left sided C6 radiculopathy was seen and treated for the clinical diagnosis of C5-C6 disc herniation. Ten days before seeking care he had received influenza and pneumococcal vaccinations. A week after vaccination, he noticed tingling, aching, and fatigue in his left arm. A week later, a rash appeared on his left arm. This was diagnosed via Teladoc as shingles; ibuprofen was prescribed, as too much time had elapsed for antiviral medication. INTERVENTION AND OUTCOME: Chiropractic spinal manipulation using Cox distraction protocols for a C5-C6 disc herniation was given 5 times over a time period of 5 weeks. This treatment resolved the patient's left arm pain, provided 50% relief for his neck pain, and decreased his left arm rash. Four spinal manipulations were given over the next 12-week period, resulting in 80% reduced neck pain, complete resolution of left arm pain, and faint herpetic rash. The patient stated that he felt he had returned to his level of health before the incident. CONCLUSION: Concurrent upper extremity radicular pain accompanied by herpes zoster cutaneous rash is described. Chiropractic spinal manipulation using Cox spinal distraction protocols saw resolution of the patient's complaints. Considered to be an uncommon dual occurrence, radiculopathy and herpes zoster infection deserve clinical discussion and evaluation of treatment protocols.

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series.

PURPOSE: The purpose of this case series is to report on changes in pain levels experienced by 69 postsurgical continued pain patients who received Cox Technic Flexion Distraction (CTFD). METHODS: Fifteen doctors of chiropractic collected retrospective data from the records of the postsurgical continued pain patients seen in their clinic from February to July 2012 who were treated with CTFD, which is a type of chiropractic distraction spinal manipulation. Informed consent was obtained from all patients who met the inclusion criteria for this study. Data recorded included subjective patient pain levels at the end of the treatments provided and at 24 months following the last treatment. RESULTS: Fifty-four (81%) of the patients showed greater than 50% reduction in pain levels at the end of the last treatment, and 13 (19%) showed less than 50% improvement of pain levels at the end of active care (mean, 49 days and 11 treatments). At 24-month follow-up, of 56 patients available, 44 (78.6%) had continued pain relief of greater than 50% and 10 (18%) reported 50% or less relief. The mean percentage of relief at the end of active care was 71.6 (SD, 23.2) and at 24 months was 70 (SD, 25). At 24 months after active care, 24 patients (43%) had not sought further care, and 32 required further treatment consisting of chiropractic manipulation for 17 (53%), physical therapy, exercise, injections, and medication for 9 (28%), and further surgery for 5 (16%). CONCLUSION: Greater than 50% pain relief following CTFD chiropractic distraction spinal manipulation was seen in 81% of postsurgical patients receiving a mean of 11 visits over a 49-day period of active care.

Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report.

INTRODUCTION: The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. CASE REPORT: A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst-induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. INTERVENTION AND OUTCOMES: Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. CONCLUSION: Lumbar synovial cyst and stenosis-generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation.

Functional scores and subjective responses of injured workers with back or neck pain treated with chiropractic care in an integrative program: a retrospective analysis of 100 cases.

OBJECTIVE: The purpose of this study is to report on integrative care for the treatment of injured workers with neck or back pain referred to a doctor of chiropractic from a medical or osteopathic provider. METHODS: This retrospective case series study evaluated data on 100 patients referred for chiropractic care of work-related spinal injuries involving workers' compensation claims. Deidentified data included age, sex, visual analog scale scores for pain, pre- and posttreatment Functional Rating Index (FRI) scores, and subjective response to chiropractic care. Based on date of injury to first chiropractic treatment, patients were subdivided as acute, subacute, or chronic injured workers. Cases were analyzed for differences in pretreatment FRI scores, posttreatment FRI scores, FRI change scores (posttreatment FRI minus pretreatment FRI score), and subjective percentage improvement using a 1-way analysis of variance. Treatment included manual therapy techniques and exercise. RESULTS: Injured workers with either an acute or subacute injury had significantly lower posttreatment FRI scores compared with individuals with a chronic injury. The FRI change scores were significantly greater in the acute group compared with either the subacute or chronic injured workers. Workers in all categories showed improved posttreatment tolerance for work-related activities and significantly lower posttreatment subjective pain scores. CONCLUSIONS: The study identified positive effects of chiropractic management included in integrative care when treating work-related neck or back pain. Improvement in both functional scores and subjective response was noted in all 3 time-based phases of patient status (acute, subacute, and chronic).

A community program to fight child abuse: the Fort Wayne Children's Foundation and Kids' Law.

This paper offers a brief review of child abuse in the United States and describes an example of a community program in Fort Wayne, Ind, to stop and reverse the adverse effects of child abuse. This commentary aims to offer resources, raise awareness, and stimulate research into child abuse incidence, type, and prevention.

Possible generators of retrotrochanteric gluteal and thigh pain: the gemelli-obturator internus complex.

OBJECTIVE: To investigate and correlate the anatomy of the gluteal region with the clinical findings of retrotrochanteric and posterior thigh pain, as seen in clinical chiropractic practice, and describe potential treatment options. METHODS: A descriptive gross anatomic study is correlated to a case presentation of a patient with deep persistent aching pain in the retrotrochanteric region of the left hip and upper posterolateral thigh. RESULTS: The structures that are located in the same location as the retrotrochanteric pain described by the patient are the gemelli-obturator internus muscle complex and associated bursae. CONCLUSIONS: In patients with persistent gluteal and sciatica-like pain, especially when centered in the retrotrochanteric region, the gemelli-obturator internus muscle complex and associated bursae should be considered as a possible source of the pain.

Chiropractic treatment of lumbar spine synovial cysts: a report of two cases.

OBJECTIVE: To present the treatment of low back and radicular pain due to synovial cysts of the lumbar spine including chiropractic distraction manipulation and physiological therapeutic care. CLINICAL FEATURES: Two patients (71-year-old man and 59-year-old woman) with magnetic resonance imaging (MRI)-diagnosed large synovial cysts at the L3 through L4 and L4 through L5 vertebral levels, respectively, had lower extremity pain, numbness, and tingling of the respective L4 and L5 dermatomes. INTERVENTION AND OUTCOME: Chiropractic distraction manipulation was performed at the level of the synovial cyst. The manipulation was performed daily until 50% pain relief was attained, followed by diminished frequency of care. Physiotherapy included positive galvanism, iontophoresis, tetanizing electrical stimulation, stabilization exercises, and home cryotherapy. The male patient's pain was reduced by 50% in 14 days and 100% at 60 days. Range of motion of the thoracolumbar spine increased, walking distance increased from 1 to 2 blocks to 1 mile without pain, and repeat MRI showed reduced size of the cyst. The female patient, under the same treatment regimen, was pain free in 6 weeks. CONCLUSION: Chiropractic distraction manipulation and physiological therapeutic care relieved 2 patients with low back and radicular pain attributed to MRI-confirmed synovial cysts of the lumbar spine. This treatment may be an initial conservative treatment option for synovial cysts with careful patient monitoring for progressive neurologic deficit which would necessitate surgery. Distraction manipulation may be a safe and effective conservative treatment of synovial cyst causing radicular pain; further data collection of clinical outcomes is warranted.