Chiropractic Care of a Patient With Neurogenic Heterotopic Ossification of the Anterior Longitudinal Ligament After Traumatic Brain Injury: A Case Report

Abstract

Objective: The purpose of this case report is to describe the use of chiropractic care for a patient with neurogenic heterotopic ossification of the anterior longitudinal ligament in the cervical spine and soft tissues of the right hip after a traumatic brain injury and right femur fracture. Clinical Features A 25-year-old military officer was referred to a hospital-based chiropractic clinic with complaints of pain and stiffness of the neck and back along with reduced respiratory excursions that began several months after a motor vehicle accident in which he had a traumatic brain injury. The patient had a fractured right femur from the accident, which had since been treated surgically, but had complications of heterotopic ossification in the soft tissues of the hip. His overall pain level was 3 of 10 on a verbal pain scale during use of oxycodone HCL/ acetaminophen. Chest excursion was initially measured at .5 cm. Intervention and Outcome: With the intent to restore respiratory chest motion and to reduce the patient's back and neck pain, the patient was placed on a program of chiropractic and myofascial manipulation, exercise therapy, and respiratory therapy. After a year of care, the patient rated overall pain at 3 of 10 verbal pain scale level but was no longer taking medications for pain and an increase in respiratory chest excursions measured at 3.5 cm. Conclusion: This case demonstrated that chiropractic treatment provided benefit to a patient with heterotopic ossification concurrent with musculoskeletal pain.

Chiropractic services in the active duty military setting: a scoping review

“…Research on the utilization, scope of practice, and policies related to chiropractic services for active duty military members globally is a small and relatively recent body of literature, with the earliest included study published in 2006. The studies were most commonly conducted in the United States ( n = 17) [16, 28–32, 34–43, 45], with one conducted in Australia ( n = 1) [33], and two in Canada ( n = 2) [12, 44]. Most studies were cross-sectional ( n = 9) [12, 28, 31–37], six were case reports [38–43], three were randomized controlled trials [29, 30, 45], and two were qualitative designs [16, 44].…”

“…post flexion injury with concurrent tinnitus, dizziness and headachesNaval Medical Center San Diego MarineChiropractic care: 8 visits; HVLA SMT, soft tissue mobilizations, advice, home exercises (stretching, strengthening, proprioceptive); Physical therapist care: 5 visits; acupunctureBaseline: VPS 7/10, painful limitation in motion, no neuro deficits, x-rays-DDD, right elongated styloid process, left calcified stylohyoid ligamentsTreatment discontinued, reported decrease stiffness, VPS 4/10, no adverse eventsReturned to work.Lillie, 2010 [42]United States40 yo, maleAcute episode LBP with radiculopathyInterdisciplinary treatment, with chiropractic care provided over 11 visits in 72 days. Treatment included HVLA and mechanically assisted SMT, interferential therapy, cryotherapy, moist heat, nutritional and psychosocial advice, exercises.Returned to regular exercise routine and able to perform all required Navy Physical Readiness Tests.Navy Military Treatment Facility Chiropractic ClinicSubjective complaints resolved and full RTD.Morgan, 2014 [43]United StatesMilitary officer 25 yo maleC3–5 ALL heterotopic ossification and ankylosisInterdisciplinary treatment including oxycodone HCL/ acetaminophen; chiropractic care: 1/wk. for 13wks, then 1/wk.…”

Integration of Chiropractic Services in Military and Veteran Health Care Facilities

“…Of these, 46 were published since the 2009 review, including 41 from literature searches and 5 found by the contributing authors. After applying the exclusion criteria, 17 new articles 10,18,20,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] were acceptable for review and added to the 13 articles 19,[37][38][39][40][41][42][43][44][45][46][47][48] reviewed in the original study. Thus, the total number of articles included in this updated review is 30.…”

Relationship between heterotopic ossification and traumatic brain injury

“…All these symptoms significantly affect the lives and emotions of patients [3] , [4] . According to different inducements, HO can be divided into three types: myositis ossificans progressiva, traumatic HO and neurogenic HO [5] . By theory, HO may occur in any part of the body, but in most of the cases it occurs in the joints, such as in the hips, elbows, and shoulders.…”

“…Recent studies have found that patients who suffered from bone fracture combined with severe traumatic brain injury (S-TBI) are at a significantly increased risk for HO [8] . The incidence of neurogenic heterotopic ossification (NHO) in patients with traumatic brain injury (TBI) is about 20%, but the rate of NHO exceeds 50% when TBI and femur fracture are concomitant [5] . In some cases, HO may be caused by brain or spinal injuries, without other injuries existing [9] .…”