Journal of the Canadian Chiropractic Association最新文献

Objective: Technique description and verification of L5 pars interarticularis (L5PI) using diagnostic ultrasound (DUS).

Methods: Asymptomatic 10-year-old male subject was scanned with diagnostic ultrasound applying a linear array transducer (8-13 MHz) over L5/S1 facets; long-axis slide cephalad to capture both superior (SAP) and inferior articulating process (IAP) of L5. Contiguous hyperechoic cortex with deep acoustic shadowing between the SAP and IAP was assumed to be L5PI. To confirm in vivo technique representing L5PI, two spine models (plastic, human spine) were scanned to verify authors' assumption. Metallic paperclip was placed over L5PI then DUS image captured. Lastly, a subject with known spondylolysis was imaged and sonographic appearance of L5PI compared.

Results: The structures localized with the metal paperclip on L5PI models were equivalent to the in vivo DUS image. Spondylolysis demonstrates an abrupt step-off defect at L5PI.

Conclusion: We report the first technique description and verification of the L5PI using DUS.

This case study documents the case of a 27-year-old female who presented with a complaint of left anterolateral thigh numbness, initially diagnosed as meralgia paresthetica with a differential diagnosis of lumbar radiculopathy. Over a span of two weeks, the patient endured emotional trauma and subsequently developed lesions in the area of complaint. The patient was diagnosed at a medical clinic with herpes zoster and was prescribed anti-viral medication which resulted in complete resolution. This case highlights the importance of considering herpes zoster as a differential diagnosis for nerverelated symptoms. Features of lumbar radiculopathy, meralgia paresthetica, varicella zoster and herpes zoster are discussed, as well as the defining characteristics and treatment options. Practitioners must remain vigilant in suspicion of viral infections such as herpes zoster even with lower incidence due to approved vaccines.

Background: Spinal epidural lipomatosis (SEL) is a rare contributor of low back pain (LBP) that can present with or without radicular symptoms.

Case presentation: A 51-year-old and 65-year-old male presented with chronic LBP to the Veterans Affairs chiropractic clinic for a trial of care. One had a moderate degree of lumbar spinal stenosis with known SEL and the other had severe. The patient with moderate grade stenosis responded favorably with weeks of transient benefit after visits and the patient with severe grade did not find benefit with care.

Summary: SEL is a condition that conservative care providers should be aware of as a potential cause of central canal stenosis or neuroforaminal narrowing. Chiropractic management of SEL has been scarcely reflected in the published literature, but may be a viable option for transient symptom management.

We recently each completed doctoral programs where the major focus of our work was in mixed methods research. In the first part of this three-part commentary, we present an overview of mixed methods research. In the second part, we present a summary of our primary and secondary research findings from our doctoral work involving mixed methods. In a third paper, we will discuss integrating qualitative research with randomized controlled trials and how this mixed methods study design can be applied to research within the chiropractic profession. Our aim with these papers is to increase awareness amongst the chiropractic community of the value (and challenges) of using this unique methodology. We also make recommendations for improving the quality of reporting and conduct of future chiropractic mixed methods studies. Further dissemination of this work will occur through online webinars and conference presentations.

Background: Spinal Manipulative Therapy (SMT) benefits LBP patients, but its mechanism is not well documented. One hypothesis indicates that SMT restores interspinal movements. Ultrasound measurement (UM) of spinous process separation (SPS) assesses the intersegmental movements.

Methods: We used the test-retest reliability of UM between the L3, L4, L5, and S1 spinous processes on fifteen asymptomatic volunteers while lying prone on a chiropractic table. The participants then walked around for over 5 minutes, and ultrasound images were reperformed prone. UM identified the tips of the spinous processes and distances between L3-L4, L4-L5, and L5-S1. Reliability was assessed using intra-class correlation coefficient (ICC).

Results: ICC values of SPS measurements were 0.982 for L3-L4, 0.992 for L4-L5, and 0.997 for L5-S1. Rootmean square difference between the two measures were 0.35mm for L5-S1, 0.36mm for L4-L5, and 0.57mm for L3-L4.

Conclusions: This study found UM to be reliable in measuring interspinous distance.

In part 1 of this commentary, we presented an overview of mixed methods research and the rationales for using this methodology with examples from the chiropractic literature. We also introduced readers to the three core mixed methods study designs, as well as the advantages and challenges of employing a mixed methods approach. In part 2 of this series, we provide a summary of the primary and secondary findings from our doctoral work involving mixed methods research and make recommendations for improving the reporting and conduct of future chiropractic mixed methods studies.

Spinal manipulation learning requires intensive practice, which can cause injuries in students. Motor imagery (MI) paired with physical practice (PP) appears to be a suitable means to reduce the number of physical repetitions without decreasing skill outcomes. This study examines whether a session of MI paired with PP leads to a similar improvement in the ability to precisely produce peak forces during a thoracic manipulation as PP alone. Chiropractic students participated in a thoracic manipulation training program for five weeks. They were randomised in two groups: the MI+PP group performed sessions combining physical and mental repetitions with 1/3 fewer PP sessions, while the PP group performed only PP. Thoracic manipulation performance was assessed in pre and post-tests, consisting of thoracic manipulations at three different strength targets. Absolute error (AE), corresponding to the difference between the force required and the force applied by the student, was recorded for each trial. The main result revealed that AE was significantly lower in post-test than in pre-test for both groups. Despite fewer physical repetitions, the MI+PP participants showed as much improvement as the PP participants. This result supports the use of MI combined with PP to optimise the benefits of physical repetitions on thoracic manipulation learning.

This is the third of three papers in our series of articles on the use of mixed methods in chiropractic research. In this commentary, we discuss the mixed methods experimental (or intervention) design. This design is a complex mixed methods research design in which qualitative research is integrated with randomized controlled trials. We provide a brief overview of this study design as well as a case example from the literature to illustrate how this approach can be applied to research within the chiropractic profession.

Background: Lhermitte's sign is a nonspecific historical and exam finding that carries with it a differential diagnosis of cervical myelopathy, multiple sclerosis, intradural tumors, or other central nervous system pathology. Regardless of the suspected diagnosis, further diagnostic investigation is indicated to determine etiology of symptoms.

Case presentation: In this case, a 67-year-old male Veteran presents to a Veterans Affairs (VA) outpatient chiropractic clinic with an insidious 6-month onset of neck pain with historical description of a positive Lhermitte's sign, a single episode of bladder incontinence, and mild changes in upper extremity manual dexterity. These subtle historical findings prompted referral for a brain and cervical spine MRI, revealing an ependymoma in the cervical spine. Urgent neurosurgical referral was made, and the patient underwent C3-C7 laminectomy, C3-T2 fusion, and tumor resection.

Summary: This case represents an example of clinical reasoning in a VA chiropractic clinic when presented with subtle neurologic findings, and discusses the differential diagnoses and decision-making process to pursue imaging that resulted in appropriate neurosurgical management.