MEDICAL HISTORY:
The patient is a 36-year-old law student who had a one year history of pain in the cervical spine with radiation to both upper extremities, more pronounced on the right. The pain began after an injury at the gym about one year ago and symptoms have persisted since that time. She had been under the care of a Family Physician, Physiotherapist and Neurosurgeon prior to consultation at Meditech. She had 2 months of physiotherapy without any improvement and uses analgesics as required. Her Neurosurgeon had advised her to undergo a C5-6 discectomy and spinal fusion.
PHYSICAL EXAMINATION:
The patient is right handed. Her right grip strength is 55 and the left is 60 lbs. The range of motion of her shoulders was within normal limits but all movement tended to aggravate the C-spine pain. The range of motion of the cervical spine with regard to flexion, extension, lateral flexion and rotation was 70% of normal. There was moderate tenderness over C4- T1 and considerable paracervical muscle spasm, particularly on the right side. An MRI of the cervical spine revealed a focal right foraminal disc protrusion at C5-6 compromising the exiting nerve roots on the right side.
DIAGNOSIS:
Disc Herniation, C5-6 with right nerve root compression
DISCUSSION:
Between April 22nd and June 10th, the patient had 22 Laser Therapy treatments to the cervical spine with almost complete resolution of her symptoms. At the time of her most recent examination, her overall improvement was rated over 90% with regard to all symptoms. The range of motion of the C-spine had returned to normal. There was no tenderness noted and neurological examination was within normal limits.
RECOMMENDATION FOR FUTURE THERAPY:
This patient was advised to have weekly treatments for maintenance therapy decelerating to monthly therapy over the course of 6 months to 1 year.
CONCLUSION:
This case demonstrates that Laser Therapy not only relieves the symptoms of disc herniation but more importantly, directl affects the pathology that produces these symptoms.
Low-Intensity Laser Therapy (LILT) is an excellent therapeutic approach in the treatment of cervical spine disc herniation. Not only does LILT provide sustained relief of pain from this condition, but also promotes a normal cellular status.
PATHOPHYSIOLOGY OF SPINAL DISC HERNIATION:
The spinal disc serves as a cushion between the vertebrae of the spinal column. The central liquid component is called the Nucleus Pulposus and the cartilaginous ring surrounding this is the Annulus Fibrosis. These are held in place by the ligaments depicted in diagram A.
As a result of trauma or the wear and tear phenomenon accompanying an increase in age, the disc atrophies and becomes more rigid. In young individuals, the disc is soft and elastic, but like other structures in the body, loses its elasticity over the course of time. As a result of this process, the disc becomes more vulnerable to injury. In fact, even in individuals as young as 30 years, an MRI may reveal evidence of deterioration in 30% of individuals examined. As the disc atrophies and loses its elasticity, herniation or rupture may occur.
The liquid contained in the Nucleus Pulposus leads to chemical irritation of the nerve roots resulting in scar tissue formation following herniation. In addition, the cartilaginous fragments of the disc can compress the spinal cord and/or nerve roots. Symptoms are generally characterized by pain, numbness and tingling and the impairment of motor and sensory function
a) Cervical Ligaments
b) Cervical Spine & Muscles
c) Cervical spine (lateral view); Bulging disc accompanied by spinal cord compression.
d) Herniated disc (coronal view); Fluid causes chemical irritation of nerve roots and leads to the formation of scar tissue, calcification etc.