Exploring the application of the Charlson Comorbidity Index to assess the patient population seen in a Veterans Affairs chiropractic residency program.

OBJECTIVE: Chiropractic trainees require exposure to a diverse patient base, including patients with multiple medical conditions. The Veterans Affairs (VA) Chiropractic Residency Program aims for its doctor of chiropractic (DC) residents to gain experience managing a range of multimorbid cases, yet to our knowledge there are no published data on the comorbidity characteristics of patients seen by VA DC residents. We tested 2 approaches to obtaining Charlson Comorbidity Index (CCI) scores and compared CCI scores of resident patients with those of staff DCs at 1 VA medical center. METHODS: Two processes of data collection to calculate CCI scores were developed. Time differences and agreement between methods were assessed. Comparison of CCI distribution between resident DC and staff DCs was done using 100 Monte Carlo simulation iterations of Fisher's exact test. RESULTS: Both methods were able to calculate CCI scores (n = 22). The automated method was faster than the manual (13 vs 78 seconds per patient). CCI scores agreement between methods was good (κ = 0.67). We failed to find a significant difference in the distribution of resident DC and staff DC patients (mean p = .377; 95% CI, .375-.379). CONCLUSION: CCI scores of a VA chiropractic resident's patients are measurable with both manual and automated methods, although automated may be preferred for its time efficiency. At the facility studied, the resident and staff DCs did not see patients with significantly different distributions of CCI scores. Applying CCI may give better insight into the characteristics of DC trainee patient populations.

Chiropractic management of post spinal cord stimulator spine pain: a case report.

BACKGROUND: A brief overview of failed back surgery syndrome, with emphasis on low back pain status post spinal cord stimulation, and post-surgical spinal manipulation is presented. CASE PRESENTATION: Four cases of patients within the VA Connecticut Health Care System presenting between July 2014 and July 2015 reporting low back pain after surgical insertion of spinal cord stimulators are discussed. This study describes the outcomes experienced by four patients with low back pain status post implanted spinal cord stimulators receiving manual therapy in the form of lumbar spine manipulation or mobilization. CONCLUSION: All four patients denied adverse effects to spinal manipulation/mobilization and onset of new symptoms after treatment; two patients reported durable reduction in low back pain with increased tolerance to walking, standing, or lying down, one reported temporary relief of low back pain, and one reported no change in symptoms. Further investigation is needed to determine the benefit of spinal manipulation in patients with implanted spinal cord stimulators, but this study has shown the absence of adverse effects from manipulation or mobilization treatment, in regards to SCS.

Peroneal neuropathy misdiagnosed as L5 radiculopathy: a case report.

OBJECTIVE: The purpose of this case report is to describe a patient who presented with a case of peroneal neuropathy that was originally diagnosed and treated as a L5 radiculopathy. CLINICAL FEATURES: A 53-year old female registered nurse presented to a private chiropractic practice with complaints of left lateral leg pain. Three months earlier she underwent elective left L5 decompression surgery without relief of symptoms. INTERVENTION AND OUTCOME: Lumbar spine MRI seven months prior to lumbar decompression surgery revealed left neural foraminal stenosis at L5-S1. The patient symptoms resolved after she stopped crossing her legs. CONCLUSION: This report discusses a case of undiagnosed peroneal neuropathy that underwent lumbar decompression surgery for a L5 radiculopathy. This case study demonstrates the importance of a thorough clinical examination and decision making that ensures proper patient diagnosis and management.

Chiropractic management of postoperative spine pain: a report of 3 cases.

OBJECTIVE: The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain. CLINICAL FEATURES: Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies. INTERVENTION AND OUTCOMES: Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being "satisfied" with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted. CONCLUSION: In these 3 cases, patients with postsurgical spine pain responded positively to chiropractic care. Spinal manipulation/mobilization was tolerated without significant adverse effects.

Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

BACKGROUND: It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery. METHODS: A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery. RESULTS: Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%. CONCLUSION: There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made. Recommendations to individual patients must consider possible unique circumstances.