36-year old female with acute neck pain, insidious, limited cervical ROM, positive cervical tests, pain worse at night, pain described as "deep, boring, nauseating". AP and lateral cervical x-rays taken in my office revealed complete absence of C5 vertebral body. I immediately referred patient to the local ER with films in hand.
Florida:
Parents brought their 10-year old son for a second opinion to evaluate a mass on the side of his neck. Their pediatrician had sent them home and told them to check back in 3 days if it didn't resolve. I took AP and lateral cervical films. Both showed the mass but particularly concerning was the AP showed the laryngeal shadow deviated laterally from the pressure of the mass. I told them not to wait 3 days but to go directly to the local emergency department. The local hospital immediately put him in an ambulance and sent him to the children's hospital in Miami. Pediatricians at the children's hospital told the parents the next day, he wouldn't have survived the night had they not taken him to the E.D. on my recommendation, based on the x-ray findings. I had a 22-year old male present to my office complaining of bilateral low back pain and occasional mild numbness and tingling in his left leg for about 4 years following an injury at wrestling practice when he was 17 years old. Even though the complaints were moderate and his injury was 4 years old, I decided to take lumbar x-rays including oblique views. The x-rays revealed bilateral L3 and L4 pars fractures. I then took lumbar flexion/extension views which revealed a 5mm anterior translation of L4 on L5. His MRI evaluation was unremarkable and without these x-rays there would have seemed to be no contraindication to diversified adjustments including side posture. Had I not taken these x-rays, I would likely have delivered a high velocity thrust into an unstable region of the patient’s spine, potentially injuring him further. Instead, I sent him for an immediate surgical consultation. Pennsylvania:
New York:
Several days ago, a 30-year old female patient presented with a primary complaint of low back pain, neck stiffness and previous diagnosis of ocular migraines by her Neurologist. Radiographs of her Cervical and Lumbar spine were taken to evaluate her spine. A fracture of the vertebral body of C5 was found at the posterior and inferior aspect with an increase in spacing noted at the fracture site on flexion view.
California:
I had a 15-year-old girl present to my office with severe neck pain. She stated that she had no injuries or trauma that she was aware of. She just "woke up with it". The examination revealed that she was not able to turn her head at all -literally zero range of motion in any direction. Something didn't seem right and I decided to take an x-ray. Her X-ray revealed a burst fracture of C1. It turns out that her mother who signed all the consent forms and dropped her off at my office gave her strict instructions not to tell me about the minor fender bender she was in the day before. Also, the daughter explained later that she had landed on the top of her head during volleyball about a year before. After the volleyball accident she had presented to the emergency room but they decided not to take an x-ray and told her she was fine. I sent her to the emergency room. They took an x-ray and sent her home saying there was no fracture. Later the radiologist called her back insisting she return to the hospital immediately. They confirmed the fracture. I think it is quite safe to assume what would've happened if I tried to adjust her. I had a patient who was having pain in the mid thoracic region between the spine and the scapula. The patient had been to another chiropractor who did not take x-rays, and who did not get good clinical results. I examined and x-rayed the patient. I saw an abnormal mass in the lung field. I sent the patient to a local radiology center and ordered a plain film chest x-ray, the radiologist confirmed a mass in the right lung. Based upon the literature, radiation is not cumulative and has rendered no evidence of long term effects. Therefore, the doctor of chiropractic must weigh the risk of treating blindly in the presence of clear biomechanical markers. Treating blindly is often done at the expense of our patients and the malpractice carriers, especially in a scenario where little risk exists. Our concern is the adoption of recommendations or guidelines that are deficient in the published and clinical evidence at hand. There also needs to be a larger clinical and academic conversation interprofessionally, to educate organizations like the ABIM and others who access spine patients, where together we can collaboratively, across professional boundaries, devise care paths to better serve society. Dr. Mark Studin is an Adjunct Associate Professor of Chiropractic at the University of Bridgeport College of Chiropractic, an Adjunct Professor of Clinical Sciences at Texas Chiropractic College and a clinical presenter for the State of New York at Buffalo, School of Medicine and Biomedical Sciences for post-doctoral education, teaching MRI spine interpretation, spinal biomechanical engineering and triaging trauma cases. He is also the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the medical and legal communities (www.DoctorsPIProgram.com), teaches MRI interpretation and triaging trauma cases to doctors of all disciplines nationally and studies trends in healthcare on a national scale (www.TeachDoctors.com). He can be reached at DrMark@AcademyOfChiropractic.com or New Jersey:
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