Vertebral Subluxation Case Study

CT scan of the cervical spine dated 01/07/14 revealed posterior fusion from C5 through C7. There is minimal anterior subluxation of C6 on C7.

Radiculopathy must be documented by physical examination and corroborated by imaging studies and/or electrodiagnostic testing. In addition, no more than two nerve root levels should be injected using transforaminal blocks, and no more than one interlaminar level should be injected at one session. The patient is s/p C5-C7 anterior

Patient lost consciousness and awoke in the hospital. Radiograph were performed; x-rays of the chest, cervical spine, and lumbar spine as well. Results indicated fracture at the right transverse process of L4 vertebra and no significant findings in the cervical spine. However, upon referral with a diagnosis of cervical strain and lumbar strain three weeks after the accident. He presents in the clinic stating increased dizziness, headaches, and unable to move his neck. Pain is intolerable and pain medications did not make any difference. Per patient, unable to sleep owing to increased pain in the neck radiating to his spine. Upon assessment, increased a sharp pain in the bottom of the neck with tingling and numbness radiating to the side of her little finger. Pain is unrelieved with rest. HE also demonstrates weakness in his grip strength and always drops his objects when he tries to grip

Cerebrospinal fluid is a clear, colorless fluid that acts as a cushion to protect and support the brain inside of the skull, while also playing an essential role in the removal of waste products from the brain. It can be found surrounding both the brain and spinal cord. I was motivated to do research on the path that the cerebrospinal fluid takes from its formation site because of its importance in protecting the brain.

In the article, Assessment of the Cervical Spine Range of Motion After the Use of the Saunders Traction Device in Different Positioning of the Upper Extremities, cervical spine complaints are seen to be increasing due in part to our society becoming more health aware.1 The pain begins with increased tension or stiffness in the muscles of the posterior neck, with varying levels of pain that begin to spread to other areas of the body over time. The positioning of the head towards protraction, pushing forward the shoulders, and an increase in spine inclination is the cause of the pain. If this pain goes untreated, range of motion of the area will decrease, resulting in an overload of other areas attempting to compensate for the injured site. These

Based on the medical report dated 01/05/17, the patient presents for follow-up of his cervical strain. He states that he feels better. He has finished up his first round of therapy session. He requests more therapy.

On examination the cervical ROM was restricted in all planes. Spurling’s test was positive on both sides, worse on the left. Sensations to light touch were decreased in the left hand 1-2 digits, which indicates sensory losses at C6-C7 levels. This level is most remarkable on the imaging as well. The MRI revealed 3mm protrusions at C6-7, with mild canal stenosis at this level; and mild to moderate foraminal stenosis greater on the left at C6-7. The patient has tried and failed conservative treatment including, PT, TPI, and medications. In addition, the patient reported functional improvement and pain relief from the first ESI, which was performed at a different, level i.e. C7-T1. CO Guidelines state indications for ESI :injections are allowed for only a small subset of patients with radicular findings. They may be used for patients who are having significant pain that is interfering with daily functions and the active therapy necessary for recovery despite medical pain management and active therapy. Injections should be preceded by an MRI. Interlaminar injections should not be done above level C6-C7. Guidelines have been met. Medical necessity of cervical ESI has been established. Recommend

Spinal stenosis of the lumbar vertebral column is commonly found in patients with chronic lower back, in combination with lower extremity pain. Methods of treatment for the condition include: Interlaminar Epidural Injection, Transforaminal Epidural Injection and Caudal Epidural Injection. Although there is a lot of literature to be found on Caudal Epidural Injections for pain relief related to Lumbar Spinal Stenosis, Interlaminar Epidural Injections are fairly new to the world of research. Manchikanti et al., of the Pain Management Center of Paducah located in Paducah, Kentucky, tested whether or not long-lasting pain relief could be accomplished with Interlaminar Epidural Injections, and if there was a significant difference in pain relief when injections were given with lidocaine, a local anesthetic, alone versus injections given with lidocaine and steroid.

Surgery on the cervical spine used to be a major procedure. It is still a serious process,

Fracture or damage to the Lumbar vertebrae 5 may result into "foot drop with weakness of the anteriortibial, postiriortibial, loss of function by the peroneal muscle, and the damage to the sacral vertebrae 1 may result into weakness of the medial gastrocnemius muscle with impaired ankle planter flexion and loss of ankle

Lateral plantar nerve entrapment is a condition that happens when the nerve that passes from the inside of your ankle to your foot (lateral plantar nerve nerve) gets squeezed or compressed (entrapment). The nerve can get compressed between the muscles, bones, and connective tissue near the bottom of your heel. The nerve supplies many of your toe muscles and gives feeling to the outer toes on the bottom of your foot.

Cervical Spine Surgery can be performed for nerve/spinal cord decompression and spinal instability. It can either be approached from the anterior (front side) or from the posterior (back side).

Diagnosis of proximal suspensory desmitis (PSD) can be challenging (Dyson and Genovese, 2011). Local anaesthesia of the deep branch of the lateral plantar nerve (DB-LPN) was performed to assist with diagnosis in this case. Nerve blocks are not considered completely diagnostic for PSD as other surrounding structures are likely to be blocked following a single injection to block the DB-LPN (Hinnigan et al., 2014). However, the significant improvement in lameness shown in response to the block in this case was highly suggestive of PSD. Incidence of bilateral hindlimb PSD is much greater than in the forelimbs (Dyson and Genovese, 2011).

Overriding Dorsal Spinous Process, commonly known as ‘kissing spine’ or is consistent or intermitted periosteal irritation caused by narrowing of the intervetebra spaces. A diamter of 4mm between adjacent vertebral spaces is considered ordinary. If the contiguous DSP’s are touching they are clinically considered to be ‘impinging’, if the DSP’s are overlying they are considered to be ‘overriding’ (Zimmerman., et al 2012). Periosteal irritation supplemented with proportionate swelling and inflammation allows for further impingement of the thoracic dorsal spinous processes and collectively accounts for the most cause of thoracolumbar discomfort. Most commonly treated in the thoracic region between T13-18 (Kimberley French, 2013) along the midpoint of the spine where

After examination by X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), the patient was diagnosed as cervical radiculopathy, and received surgical treatment of the minimally invasive posterior cervical “key-hole” laminoforaminotomy decompression. MRI of the cervical vertebra indicated that the extruded C5-6 disc had been cleared after operation and the nerve roots were free from obvious oppression (Fig. 1).