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Case Study

Name: Mr C

Reason for consultation: Front of thigh numbness and associated low back pain.

Mr C presented to Worcester Chiropractic Clinic 12 months after injuring his low back at work. Mr C states that "something went" whilst he was lifting, but at the time there was no pain. Later, at home, Mr C was unable to rise from lying due to low back pain, and at the same time noticed the front of his left thigh was painful and numb.

Over the next two months Mr C's back pain gradually resolved to a minor level of stiffness in the mornings and post activity, however the thigh numbness remained unchanged.

After 3 months Mr C saw his GP and was prescribed Naproxen, a common pain relieving anti-inflammatory. This did not improve his pain. Subsequently, Mr C was referred to an orthopaedic consultant who requested an MRI study of his low back.

The MRI showed minor degenerative changes throughout Mr C's low back and a minor disc protrusion between the 4th and 5th lumbar vertebrae. Mr C was then recommended surgery to remove this disc protrusion.

Facet Joint Injection

Whilst awaiting surgery, Mr C consulted Worcester Chiropractic Clinic. On examination he had marked weakness of his left iliopsoas (hip flexor) and decreased sharp and soft touch sensation on the area of the thigh described as numb. There were also changes in the mechanics of Mr C's spine congruent with his complaint and a degree of wear and tear.

After four treatments, consisting of spinal manipulation, Mr C reported a 90% improvement in symptoms and muscle strength had returned to normal. After two more treatments Mr C reported no further improvements and treatment was ceased.

Mr C remains 90% improved, with no low back pain and "hardly noticeable" numbness in the front of his thigh. He has now declined surgical intervention.

Discussion

On the surface this is a very typical and not very interesting chiropractic case study. However, a second look will reveal two reasons why it is very interesting indeed.

Firstly, it is self-evident from the results of this case indicate that Mr C did not need surgical intervention. National Institute for Health and Clinical Excellence (NICE) guidelines state that for low back complaints MRI investigation should NOT be conducted until the patient has had a trial course of up to 9 sessions of manipulation, except in extraordinary circumstances. Had Mr C been referred for chiropractic treatment earlier, rather than self-referring after 12 months, as suggested by NICE guidelines, it is likely that his symptoms would have responded more quickly and more fully to treatment. Furthermore, discectomy (removal of an injured disc) carries with it many and severe risks and should only be utilised as a last resort, after conservative treatments have been tried.

The second point of interest in this case regards the nature of the surgical procedure that was suggested to Mr C. The nerve responsible for Mr C's symptoms leaves the spine between the 2nd and 3rd lumbar vertebrae, whilst the proposed operation was aimed at relieving pressure on a different nerve, that exiting between the 4th and 5th lumbar vertebrae. This is a glaring error of the most basic nature, the consequences of which would have been life-changing for Mr C.

This case demonstrates the importance of communication between medical professionals and following industry guidelines. If you are suffering from a neuromusculoskeletal complaint your GP should send you to a chiropractor for proper assessment and treatment. Not doing so can lead to serious mismanagement of patients, ineffective treatments, and hugely increased healthcare costs.

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