Main Article Content
Cervical Radiculopathy, Cervical Spine, Neck Pain
Objective: To report the successful treatment of a 20-year-old woman with symptoms of radiculopathy in her left upper lateral extremity and reversed cervical lordosis. Her symptom resolved entirely, along with improvement in physiological cervical lordosis seen on radiography after chiropractic care.
Clinical Features: A 20-year-old female university student sought care for a complaint of non-specific, gradual onset, intermittent neck pain and numbness in the left lateral arm and forearm related to prolonged computer use for about 7 months. Pain was rated 6/10 on the NRS scale. Physical examination showed reduced cervical rotation to the left by 40° and a myofascial trigger point without a referral pattern in the musculature around her cervical region. Joint play of the cervical facet joints revealed generalized restriction of motion of the lower cervical spine, especially prominent on the left. She had a positive Spurling test on the left side of the left lateral forearm and thumb and a positive cervical distraction test. Radiographs of her neck demonstrated reversed cervical lordosis, with no obvious bony degenerative changes. The working diagnosis of cervical radiculopathy of the left C6 nerve root was given based on her presentation.
Intervention and outcome: Chiropractic spinal adjustments (mainly diversified technique), motorized flexion-distraction with extension force on the cervical spine, and therapeutic exercises were performed. The patient's numbness was completely resolved by the 5th visit. The cervical range of motion (ROM) returned, and she was pain-free by the 8th visit. Reassessment in the 9th month demonstrated restoration of the cervical lordosis and sustained treatment outcome.
Conclusion: Our patient demonstrated improvement in the cervical lordotic angle and upper limb numbness after treatment. Chiropractic care can play a role in managing patients with one or both of these conditions. The associated recovery of the cervical lordotic angle and radiculopathy after chiropractic care suggest a plausible biomechanical mechanism and a potential connection between the two conditions. Further research is needed to confirm the association or causality between these findings.
2. Wainner RS, Fritz JM, Irrgang JJ, et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003;28(1):52-62.
3. Im B, Kim Y, Chung Y, Hwang S. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. J Phys Ther Sci 2015;28(3):951-5. https://doi.org/10.1589/jpts.28.951
4. Miura T, Panjabi MM, Cripton PA. A method to simulate in vivo cervical spine kinematics using in vitro compressive preload. Spine 2002;27(1):43-48.
5. Harrison DE, Harrison DD, Janik TJ, Jones EW, Cailliet R, Normand M. Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clin Biomechanics 2001;16(4):276-84. https://doi.org/10.1016/S0268-0033(01)00006-7
6. Been E, Shefi S, Soudack M. Cervical lordosis: the effect of age and gender. Spine J 2017 Jun 1;17(6):880-8. https://doi.org/10.1016/j.spinee.2017.02.007
7. Lv Y, Tian W, Chen D, Liu Y, Wang L, Duan F. The prevalence and associated factors of symptomatic cervical Spondylosis in Chinese adults: a community-based cross-sectional study. BMC Musculoskeletal Disorders 2018;19(1):1-2. https://doi.org/10.1186/s12891-018-2234-0
8. Choudhary BS, Sapur S, Deb PS. Forward head posture is the cause of straight spine syndrome in many professionals. Indian journal of occupational and environmental medicine. 2000;4(3):122-4.
9. Frostell A, Hakim R, Thelin EP, Mattsson P, Svensson M. A review of the segmental diameter of the healthy human spinal cord. Frontiers Neurol 2016;7:238. https://doi.org/10.3389/fneur.2016.00238
10. Leung KK, Chu EC, Chin WL, Mok ST, San Chin EW. Cervicogenic visual dysfunction: an understanding of its pathomechanism. Medicine Pharmacy Reports 2022 Jun 24.
11. Chu EC, Chin WL, Bhaumik A. Cervicogenic dizziness. Oxford Med Case Reports 2019;2019(11):476-8.
12. Butler DS. Adverse mechanical tension in the nervous system: a model for assessment and treatment. Australian J Physiotherap 1989;35(4):227-38. https://doi.org/10.1016/S0004-9514(14)60511-0
13. Breig A, Turnbull I, Hassler O. Effects of mechanical stresses on the spinal cord in cervical spondylosis: a study on fresh cadaver material. J Neurosurg 1966;25(1):45-56. https://doi.org/10.3171/jns.1966.25.1.0045
14. Gao K, Zhang J, Lai J, et al. Correlation between cervical lordosis and cervical disc herniation in young patients with neck pain. Medicine 2019;98(31). doi: 10.1097/MD.0000000000016545
15. Chu EC. Alleviating cervical radiculopathy by manipulative correction of reversed cervical lordosis: 4 years follow-up. J Family Med Primary Care 2021;10(11):4303-06. doi: 10.4103/jfmpc.jfmpc_648_21
16. Chu EC, Lim T, Mak KC. Cervical radiculopathy alleviating by manipulative correction of cervical hypolordosis. J Med Cases 2018;9(5):139-41. https://doi.org/10.14740/jmc3051w
17. Kumagai G, Ono A, Numasawa T, Wada K, Inoue R, Iwasaki H, Ishibashi Y, Iwane K, Matsuzaka M, Takahashi I, Umeda T. Association between roentgenographic findings of the cervical spine and neck symptoms in a Japanese community population. J Orthop Sci 2014;19(3):390-7.
18. McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005;28(3):187-93.
19. Guo GM, Li J, Diao QX, Zhu TH, Song ZX, Guo YY, Gao YZ. Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res 2018;13(1):1-7
20. Shilton M, Branney J, de Vries BP, Breen AC. Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. Chiropr Man Ther 2015;23(1):1-9.
21. Christensen KD, Buswell K. Chiropractic outcomes managing radiculopathy in a hospital setting: a retrospective review of 162 patients. J Chriopr Med 2008;7(3):115-25. https://doi.org/10.1016/j.jcm.2008.05.001
22. Schoenfeld AJ, George AA, Bader JO, Caram Jr PM. Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009. J Spinal Disorders 2012;25(1):17-22. doi: 10.1097/BSD.0b013e31820d77ea
23. Kang KC, Lee HS, Lee JH. Cervical radiculopathy focus on characteristics and differential diagnosis. Asian Spine J 2020;14(6):921-30. doi: 10.31616/asj.2020.0647
24. Lees F, Turner JA. Natural history and prognosis of cervical spondylosis. Br Med J 1963;2(5373):1607-10.
25. Childress M, Becker BA. Nonoperative management of cervical radiculopathy. American Family Phys 2016;93(9):746-54.
26. Thoomes EJ. Effectiveness of manual therapy for cervical radiculopathy, a review. Chiropr Man Ther 2016;24(1):1-1. https://doi.org/10.1186/s12998-016-0126-7
27. Murphy DR, Hurwitz EL, Gregory A, Clary R. A non-surgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study. J Manipulative Physiol Ther 2006;29(4):279-87. https://doi.org/10.1016/j.jmpt.2006.03.005
28. Peterson CK, Schmid C, Leemann S, Anklin B, Humphreys BK. Outcomes from magnetic resonance imaging–confirmed symptomatic cervical disk herniation patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up. J Manipulative Physiol Ther 2013;36(8):461-7. https://doi.org/10.1016/j.jmpt.2013.07.002
29. Oakley PA, Ehsani NN, Moustafa IM, Harrison DE. Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: a systematic review of controlled trials. J Phys Ther Sci 2021;33(10):784-94. https://doi.org/10.1589/jpts.33.784
30. Wickstrom BM, Oakley PA, Harrison DE. Non-surgical relief of cervical radiculopathy through reduction of forward head posture and restoration of cervical lordosis: a case report. J Phys Ther Sci 2017;29(8):1472-1474. https://doi.org/10.1589/jpts.29.1472