Case Reports
Chiropractic Care of Acute Low Back Pain and Incidental Spina Bifida Occulta: A Case Report

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Abstract

Objective

The purpose of this case report is to describe chiropractic care of an adolescent with acute low back pain and incidental finding of spina bifida occulta managed with high-velocity low-amplitude manipulation.

Clinical Features

A 10-year-old boy was referred for chiropractic care by his pediatrician for the management of low back pain after a fall 3 days prior. Examination and medical records revealed the patient also had spina bifida occulta at the level of L5.

Intervention and Outcome

High-velocity low-amplitude treatment for lower back pain showed resolution of patient's pain after 6 visits. No adverse effects were reported.

Conclusion

An adolescent patient with lower back pain and incidental finding of spina bifida occulta improved with a course of care that included with high-velocity low-amplitude manipulation therapy.

Introduction

Low back pain is common, and chiropractic manipulative therapy is frequently used for treatment of acute low back pain.1 High-velocity low-amplitude (HVLA) has been demonstrated to be an effective treatment modality for the management of acute low back pain when compared to standard medical care.1 High-velocity low-amplitude adjustments have been proven to be a superior treatment compared to prescription nonsteroidal anti-inflammatory drugs.2

Spina bifida occulta (SBO) is a common anomaly of the spine present at birth.3 It is a condition arising during neurological development that is the result from the neural tube failing to close, which normally closes by the fourth week of gestation. In the spine, this developmental abnormality typically presents as an incomplete fusion of the lamina without affecting the spinal cord.3, 4, 5 According to clinical studies, around 20% of the population may have SBO.6, 7 It usually is present at the levels of the 5th lumbar and 1st sacral vertebra.6, 8, 9 Spina bifida occulta in most cases is asymptomatic, but symptoms among the population may include back pain, enuresis, motor or sensory dysfunction, and posterior disc herniation.7, 9, 10 Fusion of vertebral lamina forms the spinous process, and this process serves as attachment sites for many extensor muscles. Muscles such as the mutifidus are essential in trunk stability and play a role in lumbar support and posture.11 Spina bifida occulta is classified as a congenital anomaly, which may present with other conditions of the spine such as disc herniation and spondylolysis.9, 12, 13 Spina bifida occulta can go undiagnosed and may only present as a nonunion of the spinous process seen on radiographs.

Physical examination findings often include a patch of hair present on the dermis above L4/L5 segments.14 Decreased range of motion in the spine and pain with extension are other possible findings. Postnatal diagnosis of SBO is best found initially with the use of radiographs of the lumbar spine.9, 15 Radiograph findings can be confirmed using computerized tomography or magnetic resonance imaging. However, after SBO has been diagnosed, clinicians may be unclear if HVLA can be sued as a treatment for those patients who also have low back pain.

Currently, there are no published manuscripts stating that adolescents with lower back pain along with SBO can be treated successfully with HVLA. Therefore, the purpose of this article is to describe chiropractic management of a 10-year-old adolescent with lower back pain and incidental finding of SBO.

Section snippets

Case Report

A 10-year-old boy was referred for chiropractic care for lower back pain and muscle spasm by his pediatrician. During history taking at the chiropractic office, the mother expressed concern about her son's spinal deformity at the initial encounter and was protective of him and had limited him from strenuous activities. Upon inquiry, the patient and his mother reported that the achy pain was localized to the lower lumbar spine at a 5/10 severity using a numeric rating scale. The mechanism of

Discussion

In the case of this adolescent patient, low back pain was present after a traumatic fall, and he was referred by his pediatrician for chiropractic care. An incidental finding of SBO was present, which was the mother's main concern. With around 20% of the population having SBO, chiropractic physicians are very likely to encounter this incidental finding in their practices.6, 7 Anomalies within the spine are not uncommon, but are sometimes overlooked due to their benign presentation.6 Few studies

Limitations

This was the report of one patient, and each case of SBO is unique. Therefore, the findings of this case cannot be extrapolated to other cases. He had experienced a traumatic fall and a previous car accident, which may have been the contributing factors of low back pain. Research obtained stated that presence of SBO in lumbar spine could present with worse pain, which may be unrelated in this case due to child's previous history. Other limitations include patient subjective response due to

Conclusion

This case report describes the resolution of lower back pain in an adolescent patient with an incidental finding of L5 SBO who was treated with HVLA manipulation. This study demonstrates that HVLA was beneficial for this patient's lower back pain and that there were no adverse reactions, despite the presence of a coincidental SBO.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

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1

B.C.A. and E.R.S. completed this work while they were students at the Palmer College of Chiropractic Clinics in Florida.

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