Intermittent Cervical Traction and Thoracic Manipulation for Management of Mild Cervical Compressive Myelopathy Attributed to Cervical Herniated Disc: A Case Series

Browder, David A.

doi:10.2519/jospt.2004.1519

Cited by 10 publications

(22 citation statements)

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“…14 There have been published case reports of patients with cervical compressive myelopathy comanaged successfully with nonsurgical medical treatments and different combinations of manual therapies including spinal manipulation, spinal mobilization, neural mobilization, and traction. 17,19 However, current treatment recommendations for thoracic myelopathy include only surgical approaches. There are no nonsurgical recommendations or case reports for conservative management of thoracic myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic

Bishop

Beres

2012

Journal of Chiropractic Medicine

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Introduction: The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic. Case Report/Methods: After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult. Results: Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement. Conclusion: It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic

Bishop

Beres

2012

Journal of Chiropractic Medicine

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“…One of the initial judgment's of a CPR's validity is whether the predictors that emerge have biologic plausibility for their inclusion [7]. In clinical studies reporting success with cervical traction, patient populations included those with cervical radiculopathy or compressive myelopathy [1,6,36,48,51]. Several preliminary studies attempting to identify the sub-group of patients with neck pain like to benefit from traction have included patients with distal symptoms who demonstrate signs of nerve root compression [10,21].…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have suggested clinical criteria for identifying patients with neck pain likely to respond to traction [6,21,48,61]. Experts generally agree that traction is most appropriate for patients with neck and upper extremity symptoms, and signs of neurological compromise, for whom centralization of symptoms is a treatment goal [47].…”

Section: Introductionmentioning

confidence: 99%

Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise

Raney

Petersen

Smith³

et al. 2009

Eur Spine J

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The objective of the study was to develop a clinical prediction rule (CPR) to identify patients with neck pain likely to improve with cervical traction. The study design included prospective cohort of patients with neck pain referred to physical therapy. Development of a CPR will assist clinicians in classifying patients with neck pain likely to benefit from cervical traction. Eighty patients with neck pain received a standardized examination and then completed six sessions of intermittent cervical traction and cervical strengthening exercises twice weekly for 3 weeks. Patient outcome was classified at the end of treatment, based on perceived recovery according to the global rating of change. Patients who achieved a change C?6 (''A great deal better'' or ''A very great deal better'') were classified as having a successful outcome. Univariate analyses (t tests and chi-square) were conducted on historical and physical examination items to determine potential predictors of successful outcome. Variables with a significance level of P B 0.15 were retained as potential prediction variables. Sensitivity, specificity and positive and negative likelihood ratios (LRs) were then calculated for all variables with a significant relationship with the reference criterion of successful outcome. Potential predictor variables were entered into a step-wise logistic regression model to determine the most accurate set of clinical examination items for prediction of treatment success. Sixty-eight patients (38 female) were included in data analysis of which 30 had a successful outcome. A CPR with five variables was identified: (1) patient reported peripheralization with lower cervical spine (C4-7) mobility testing; (2) (2009( ) 18:382-391 DOI 10.1007 test; (3) age C55; (4) positive upper limb tension test A; and (5) positive neck distraction test. Having at least three out of five predictors present resulted in a ?LR equal to 4.81 (95% CI = 2.17-11.4), increasing the likelihood of success with cervical traction from 44 to 79.2%. If at least four out of five variables were present, the ?LR was equal to 23.1 (2.5-227.9), increasing the post-test probability of having improvement with cervical traction to 94.8%. This preliminary CPR provides the ability to a priori identify patients with neck pain likely to experience a dramatic response with cervical traction and exercise. Before the rule can be implemented in routine clinical practice, future studies are necessary to validate the rule. The CPR developed in this study may improve clinical decision-making by assisting clinicians in identifying patients with neck pain likely to benefit from cervical traction and exercise.Eur Spine J

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“…7,37 Multiple case series 7,37 have demonstrated the positive effects of ICT. In addition to ICT, thoracic thrust joint manipulation (TJM) is gaining favor in the treatment of patients with cervical disorders.…”

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confidence: 99%

“…In addition to ICT, thoracic thrust joint manipulation (TJM) is gaining favor in the treatment of patients with cervical disorders. 7,11,22,41 Because of the biomechanical influence of the thoracic spine on the cervical spine, abnormal joint mobility in the thoracic spine can lead to disturbances of the cervical spine. 7,18,41 It has also been suggested that proper thoracic spine mechanics reduces mechanical stressors placed on the cervical spine.…”

mentioning

confidence: 99%

Diagnosis and Treatment of Cervical Radiculopathy Using a Clinical Prediction Rule and a Multimodal Intervention Approach: A Case Series

Waldrop¹

2006

J Orthop Sports Phys Ther

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Study Design: Case series. Objectives: To describe an established method of diagnosing cervical radiculopathy (CR) using a clinical prediction rule (CPR), and to describe the management of 6 patients using intermittent cervical traction (ICT), thoracic thrust joint manipulation (TJM), and exercise. Background: Many patients present with unilateral arm pain without having undergone magnetic resonance imaging (MRI) of the cervical spine. Using a CPR has demonstrated high levels of specificity to rule in cervical radiculopathy. ICT and manual therapy (including thoracic TJM) are widely used in clinical settings to treat cervical radiculopathy. Case description: Six patients (3 men, 3 women) were diagnosed with cervical radiculopathy using the CPR. All patients were treated with ICT, thoracic TJM, and exercise. The Northwick Park Neck Questionnaire served as the outcome measure. Outcomes: The CPR accurately identified CR (secondary to a disc herniation) in 4 out of 4 patients when compared to the results of a reference standard (MRI). Six patients were seen from 5 to 18 sessions over a 19-to 56-day period. Reduction in Northwick Park Neck Questionnaire scores ranged from 13% to 88%. One patient did not improve significantly and underwent neck surgery. Discussion: Using the CPR may be beneficial in diagnosing CR, so the clinician can devise a plan of care and assess treatment outcomes in a relatively homogenous group of patients. It is possible that a treatment regimen of ICT, thoracic TJM, and exercise will aid in centralizing radicular symptoms and improving functional outcomes in patients with CR. J Orthop Sports Phys Ther 2006;36:152-159.

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Intermittent Cervical Traction and Thoracic Manipulation for Management of Mild Cervical Compressive Myelopathy Attributed to Cervical Herniated Disc: A Case Series

Cited by 10 publications

References 0 publications

Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic

Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic

Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise

Diagnosis and Treatment of Cervical Radiculopathy Using a Clinical Prediction Rule and a Multimodal Intervention Approach: A Case Series

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