Objective: Demonstrate how conservative management using flexion- distraction to multiple causes of neck complaints can successfully be treated with co-management and cooperation between healing disciplines.
Clinical Features: A 43 year old male patient returned to the clinic with left side neck pain, left arm numbness and numbness in the left thumb, index and middle finger. Imaging revealed a "C5-C6 broad based 1-2 mm AP 1-2mm left posterolateral foramina and mostly foraminal protrusion, superimposed upon an uncinate osteophyte, impinging upon the exiting left C6 nerve root in the severely stenotic left neural foramen. This is superimposed on an annular bulgeosteophyte that produces mild central canal stenosis to 10mm AP midline dimension, with no cord impingement. Left uncinate osteophyte and a 2mm soft herniation at the left foraminal entrance zone, with impingement upon the left C7 root, entering within the moderately stenotic left foramen. Mild right foraminal stenosis".
Outcome: The patient had been treated for neck pain in the past. Nevertheless he was counseled about the presenting complaints and findings. Different chiropractic and medical treatment protocols were outlined for this condition. The treatment for these presenting complaints and findings included a course of flexion-distraction and a surgical consultation. The patient responded favorably and was dismissed from active care after 14 in office sessions. When the surgical consultation occurred, the patient had been responding to care and a "wait-and-see" strategy was employed by the orthopedic surgeon about the need for more aggressive treatment.
Conclusion: Cox© flexion-distraction provided a conservative treatment plan for a difficult case to manage. Referral for a surgical consultation was appropriate noting the extensive changes. Working with a surgeon who understands the flexiondistraction protocols was helpful in this case. The treating clinician was able to reduce patient anxiety about their condition by the patient understanding the team approach to care.
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