This topic contains 3 replies, has 2 voices, and was last updated by 
Scott Glidden July 18, 2018 at 4:57 pm.
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Scott Glidden
54 year old female presents with L radiating neck to arm/hand pain for last two months after car crash in 2/2018. Previous crash in 1998, no treatment. Currently a 3/10 ache but gets up to 9/10 ache and as low as 2/10. Sitting makes it worse and laying down makes it better, however she often wakes up with a “choking” sensation after 20 minutes of sleep.
UCF: 15 CF:37 CTF: 48 Adhesions present in B RCPmin, L superior oblique,L cervical erectors. First visit improved UCF 3 degrees, and then she brought her MRI. WHOA! She has some diagnosed anxiety/PTSD issues and is self-aware of her condition and wants to know what a reasonable outcome is for her. I said that she has adhesion that can be treated, but with this imaging its not likely she will see full resolution of her symptoms. We will improve her function as much as we can and then when we clear out all the adhesion we will be left with what’s left.
MRI report states broadbased disc bulge at C3/4, 4/5 and 5/6 with bilateral uncovertebral changes at those levels as well as bilateral canal stenosis at those levels.
How do I best manage this patient treatment and her expectations?
William Brady, DC
You are definitely following the ID process properly. That’s great. With large irreducible blocks let her know you can help some and we will see how it goes when the adhesion is reduced.
Another less her is how helpful imaging is up front.
Christopher Stepien
TY for sharing the cases Scott.
Can we directly correlate “Choking” with anterior displacement of the discs? In Scott’s MRI, we can see that the disc moves the soft tissue anterior to the vertebra.
I currently have 3 patients with this “choking” data point that have at best, been mildly relieved with Tx (relief means that “choking” was anterior neck contraction to counteract adhesion in the posterior cervical spine). I don’t have MRIs of any of these patients to confirm the correlation.
One of these patients has severe choking and is worried (as am I) that with further progression, she won’t be able to swallow.
Is surgery helpful to reduce this type of problem? While the trachea/esophagus are located there, it seems like it might be a straightforward surgery to remove that disc material since there is no bone in the way.
Scott Glidden
Thanks for the input Chris! At her 2nd appointment today she said she felt much better after treatment (1/10 discomfort). While treating her today she did get the choking sensation when she was in flexion. Once tx has wrapped up I will certainly bring that procedure up as an option if the sensation persists!
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