Degenerative Cervical Myelopathy in a Veteran Chiropractic Patient Referred for Lumbar Radicular Pain: A Case Report.

OBJECTIVE

The purpose of this report is to describe a patient with progressive neurological signs during a trial of chiropractic care for lumbar radicular pain.

CLINICAL FEATURES: A 72-year-old male US Veteran presented for chiropractic care with left lower extremity pain and numbness and tingling in both hands and feet. The patient's comorbidities included stage IV b-cell lymphocytic leukemia currently in remission, scleroderma, diabetes mellitus with previously diagnosed peripheral neuropathy, hemolytic anemia, and osteoporosis from long-term corticosteroid use. Initial evaluation was unremarkable for neurological findings, a re-evaluation revealed new signs suggestive of myelopathy including brisk patellar reflexes and a unilateral Hoffman's sign. Lumbar spine radiographs were requested and demonstrated moderate, diffuse spine-related degenerative changes.

INTERVENTION AND OUTCOME: After 5 sessions of chiropractic flexion-distraction manipulation to the lumbar spine, soft-tissue therapy, and sciatic nerve mobilization exercises, the patient improved. However, at re-evaluation progressive neurological findings warranted primary care coordination for the request of advanced imaging due to suspicion of cervical myelopathy. A cervical MRI revealed severe cervical spinal stenosis with impingement upon the cervical cord at C3-C4. A neurosurgical consult was placed by the requesting physician for surgical consideration.

CONCLUSION

This case highlights the challenges associated with early signs of degenerative cervical myelopathy and its variable presentation. It highlights the importance of performing routine re-evaluations when managing multimorbid neuromusculoskeletal conditions and how signs of chronic conditions, such as degenerative cervical myelopathy, may rapidly manifest.