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Patient: Female, 62-year-old Final Diagnosis: Cervical spondylosis • syringomyelia Symptoms: Headache • neck pain • upper extremity numbness and weakness Medication: — Clinical Procedure: Exercises • soft tissue manipulation • spinal mobilization • therapeutic ultrasound Specialty: Chiropractic Objective: Rare disease Background: Patients with Arnold-Chiari Malformation I (CM-I) treated with foramen magnum decompression (FMD) can have ongoing neck pain, headaches, and other symptoms complicated by persistent syringomyelia, yet there is little research regarding treatment of these symptoms. Case Report: A 62-year-old woman with a history of residual syringomyelia following FMD and ventriculoperitoneal shunt for CM-I presented to a chiropractor with progressively worsening neck pain, occipital headache, upper extremity numbness and weakness, and gait abnormality, with a World Health Organization Quality of Life score (WHO-QOL) of 52%. Symptoms were improved by FMD 16 years prior, then progressively worsened, and had resisted other forms of treatment, including exercises, acupuncture, and medications. Examination by the chiropractor revealed upper extremity neurologic deficits, including grip strength. The chiropractor ordered whole spine magnetic resonance imaging, which demonstrated a persistent cervico-thoracic syrinx and findings of cervical spondylosis, and treated the patient using a multimodal approach, with gentle cervical spine mobilization, soft tissue manipulation, and core and finger muscle rehabilitative exercises. The patient responded positively, and at the 6-month follow-up her WHO-QOL score was 80%, her grip strength and forward head position had improved, and she was now able to eat using chopsticks. Conclusions: This case highlights a patient with neck pain, headaches, and persistent syringomyelia after FMD for CM-I who improved following multimodal chiropractic and rehabilitative therapies. Given the limited, low-level evidence for these interventions in patients with persistent symptoms and syringomyelia after FMD, these therapies cannot be broadly recommended, yet could be considered on a case-by-case basis.

Glucosamine chondroitin is a popular dietary supplement used for joint health and osteoarthritis pain and is one of the dietary supplements commonly recommended by chiropractors. Herein, we present the case of a 36-year-old woman who developed a skin rash with delayed onset after taking glucosamine and chondroitin pills for lumbar degenerative joint disease. Within 3 hours of taking the supplement, she developed an itchy rash on her torso and legs. Over the next few hours, the rash spread over her entire body, and facial swelling developed. Given the timing of the symptoms after the administration of glucosamine chondroitin, an allergic reaction was suspected. The supplement was withdrawn and the allergic reactions were treated with antihistamines and steroids for several days. This case report demonstrates the need to recognize delayed allergic reactions as a potential side effect of widely used supplements, such as glucosamine chondroitin, which can produce hypersensitivity reactions in sensitive individuals.

Cases of lumbar and gluteal pain are commonly encountered in chiropractic clinics, with a broad differential diagnosis primarily centered on musculoskeletal conditions. This report presents the second documented case of sacral chordoma diagnosed at a chiropractic clinic and emphasizes the importance of considering alternative diagnoses and interdisciplinary collaboration in patient care. A 42-year-old man presented to a chiropractic clinic with complaints of lumbar and gluteal pain. The initial conservative management based on a presumptive musculoskeletal diagnosis was ineffective. Suspicion of an alternative etiology prompted a referral for imaging, which revealed a sacral chordoma. An interdisciplinary collaboration involving orthopedic surgeons, oncologists, radiologists, and other healthcare professionals was initiated to optimize the treatment outcomes of this rare and aggressive tumor. This case report underscores the importance of maintaining a high index of suspicion in cases of musculoskeletal presentations in chiropractic clinics and the critical role of advanced imaging in establishing a definitive diagnosis. Interdisciplinary collaboration is essential for managing complex conditions such as sacral chordomas, ensuring the delivery of the highest quality of care, and optimizing patient outcomes. Chiropractors play a crucial role in identifying, referring, and contributing to the management of patients with complex presentations as part of a comprehensive multidisciplinary treatment plan.

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Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.