Case Study: Flexion-Distraction for Cervical Stenosis
Spinal stenosis, a narrowing of the spinal canal or tunnels through which nerves travel, can be difficult to diagnose clinically. Plain film radiographs may show nonspecific signs of degeneration, but advanced imaging using computed tomography and magnetic resonance imaging can demonstrate the extent of spinal stenosis.
Flexion-distraction technique, while commonly used and investigated for lumbosacral conditions, is a fairly uncommon treatment strategy for cervical conditions. Thus, little literature exists pertaining to the use of this technique in the cervical region; this case report describes and discusses the use of this procedure for a patient with cervical spinal stenosis.
A 60-year-old man presented with stiffness and shooting pain radiating from his neck down his left shoulder and arm. Pain increased when looking up or turning his head; weakness and heaviness were also present in his left arm. Symptoms had first appeared four months prior, possibly due to a fall or blow to the head. Medication and physical therapy provided no relief. Several signs of neurological involvement were elicited upon physical examination, including positive foraminal compression test; hyper-reflexic upper extremity deep tendon reflexes; C6 dermatome hypesthesia; and a positive Hoffman’s reflex. Radiographs showed degenerative changes, and MRI examination showed degenerative disc disease in the lower cervical spine with resultant effacement of the cord at several levels. IVF encroachment was also present unilaterally at C4/C6, C5/C6 and bilaterally at C6/C7.
Following adjunctive therapies, including hot packs, flexion-distraction was provided using the flexion-distraction table cervical headpiece in right lateral bending prior to performing flexion. Five sets of five, four-second repetitions were applied to the patient while the doctor contacted the T1/T2 level to treat the whole cervical spine. The patient was given three treatments weekly for five weeks, then four additional treatments over the next several months. Cervical spine stretching and strengthening exercises were given to the patient for home care. Eight weeks after beginning treatment, the patient displayed normal upper-extremity reflexes, strength and sensations, with reduced pain and "greatly improved" neck range of motion.
Common treatments for cervical stenosis include immobilization; physiotherapy; medication; rehabilitation; surgery; and chiropractic, according to the authors. They conclude that these results suggest flexion-distraction is also a viable option for treating this difficult-to-manage condition.
Note: This case report provides a nice overview of the diagnostic and treatment methods often used in managing cervical spinal stenosis, and a clear presentation of how flexion-distraction was used in this case.
Kruse RA, Gregerson D. Cervical spinal stenosis resulting in radiculopathy treated with flexion-distraction manipulation: A case study. Journal of the Neuromusculoskeletal System 2002:10(4), pp. 141-147.
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