Case reportChiropractic management using Cox cervical flexion-distraction technique for a disk herniation with left foraminal narrowing in a 64-year-old man
Introduction
Cervical radiculopathy is compression of exiting nerve root(s) by various tissues such as disk herniation or arthritic change, which usually presents as pain or abnormal sensations along a dermatomal distribution. It peaks in the fourth and fifth decades of life and has an annual incidence of 2.1 per 1000.1 Conservative treatment, including chiropractic, is used primarily2,4, 5, 6, 7, 8,16, 22, 23; but for those who do not respond, surgery is an option.3
Cox flexion-distraction is a chiropractic joint manipulation/mobilization technique that can be applied to patients with cervical radiculopathy. At this time, however, there are only 4 case studies and 1 retrospective study addressing Cox flexion-distraction and cervical spine disorders.4, 5, 6, 7, 8 In contrast, Cox flexion-distraction has more extensive representation in the literature for the treatment of low back pain. One study compared the short-term results of Cox flexion-distraction and physical therapy, and 2 follow-up studies evaluated the long-term outcomes for low back pain.9, 10, 11 The first study demonstrated improvement in chronic low back pain with the Cox flexion-distraction technic.9 The 2 follow-up studies showed the following 1-year outcomes: (1) compared with the physical therapy group, the Cox flexion-distraction group required far fewer visits to health care providers10; and (2) Cox flexion-distraction was more effective than physical therapy in reducing pain.11
This case study describes the chiropractic management of a patient with cervical disk herniation with concomitant radiating pain in the left upper extremity and hypoesthesia/anesthesia in the palmar side of the left hand.
Section snippets
Case report
A 64-year-old African American presented on March 5, 2010, for evaluation of upper back and lower neck pain with left upper extremity radiating pain and hypoesthesia/anesthesia symptoms in the palmar side of the left hand. His pain began on October 7, 2009, when he was stretching, originating in the upper back and lower neck. Over the course of 2 months, the pain spread to his left shoulder and then began radiating down his left arm to the elbow. Below the elbow, he experienced at times both
Discussion
There are various approaches to cervical disk herniations and associated pain. Medical interventions consist primarily of analgesics, muscle relaxants, injections, and surgery. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders reviewed all literature from 1980 to 2006 related to neck pain alone or neck pain with radicular signs, in the absence of serious disease.17 It found no support for radiofrequency neurotomy, cervical facet injections, cervical
Limitations
The main limitation of this study is that multiple assistive modalities were used alongside the Cox flexion-distraction protocols. Although the Cox protocols were the most consistently and rigorously applied treatments, the presence of additional modalities may confound the conclusion that Cox flexion-distraction provided the greatest relief of symptoms.
Another limitation of this study is that only a single patient was reported and, therefore, the findings may not necessarily be generalizable
Conclusion
This case study showed successful treatment of a patient with confirmed cervical disk herniation with radiating pain and loss of sensation. Cox flexion-distraction applied to the cervical spine, along with assistive modalities such as Active Release Techniques, Graston Technique, and therapeutic exercises, led to full recovery. Eight months after the final treatment, the patient remained pain-free and fully functional.
Funding sources and potential conflicts of interest
No funding sources or conflicts of interest were reported for this study.
Acknowledgment
The author thanks Jennifer Hepps, MD, for her help with this manuscript and John Reeder, MD, FACR, for his help with the diagnostic imaging portion of this study.
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