Case Study 3:
Cervical Myelopathy

Debbie, a 62–year-old female nonsmoker with a past medical history of asthma, hypertension, and bilateral carpal tunnel syndrome status post bilateral surgical decompression presented to a chiropractor in an integrative setting with a three-month exacerbation of frequent neck pain and tightness, with constant numbness and tingling in her hands diffusely and bilaterally (Figure 1). She rated her current neck pain 3/10 on the numeric rating scale with occasional severe pain at 8/10. She also noted a sensation of warmth along the lateral torso in the region inferior to the axilla extending to the iliac crest (Figure 2). The patient noted that it was hard to hold a pencil and tie her shoes, she dropped things frequently, and had difficulty performing tasks at work due to weakness of her hands. She also reported a reduction in sleep to less than six hours due to her symptoms. She denied any difficulties with walking or bowel or bladder disturbances.

Ten years prior to presentation to the chiropractor, she developed neck pain after she slipped and fell backward on ice. This prompted her to go to the emergency department, where she had radiographs of her cervical spine showing mild degenerative changes at C5–6 and C6–7 (Figure 3). Providers referred her to physical therapy, and according to her physical therapist’s recommendation, she purchased a cervical traction device (Saunders) and used this regularly about a year until her symptoms improved.

Sixteen months prior to presentation she had an episode of moderate-to-severe left neck, shoulder, and arm pain, described as a generalized aching pain, which was keeping her up at night and causing her to become nauseous. She visited her primary care provider, who ordered cervical spine radiographs. These were notable for a grade 1 (i.e., less than 25%) degenerative anterolisthesis of C4 on C5, and multilevel spondylosis (Figure 4). Her primary care provider diagnosed her with cervical radiculopathy and again referred her for physical therapy. The patient also resumed using the cervical traction device at home. The patient reported improvement of her pain with physical therapy, yet noted ongoing numbness and tingling in the right upper extremity. After a brief period of relief, her symptoms fully returned.

Seven months prior to presentation, the patient presented to her primary care provider noting constant neck pain and radiating pain and numbness in the right upper extremity worsened with neck rotation. She noted neck pain that radiated into the right upper extremity when turning her neck to the right side. The primary care provider ordered a cervical spine MRI, the report for which noted moderate spinal canal stenosis from C5 through C7 (Figure 5), severe right foraminal narrowing at C5–6, and severe left neural foraminal narrowing at C6–7. The primary care provider diagnosed the patient with cervical radiculopathy and referred her to pain management.

Two months prior to presentation, the patient saw a pain management specialist who suspected the patient had cervical radiculopathy, secondary fibromyalgia, and had a recurrence of carpal tunnel syndrome. The pain management specialist performed an intramuscular injection of ketorolac tromethamine 60 mg, and later performed a bilateral interlaminar epidural steroid injection at C6–7. This provider also recommended coenzyme Q10 and B-complex vitamins. These therapies did not provide the patient with any relief, and the provider referred the patient to the chiropractor.