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C-SPine and T-Spine Discs Where to start/Manage

Exit forum ID Forum Discussion C-SPine and T-Spine Discs Where to start/Manage

This topic contains 3 replies, has 2 voices, and was last updated by   Brandon Cohen DC, CSCS October 28, 2019 at 11:13 am.

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    Jamie Hansen

      Hi Everyone,
      I was hoping to get some insight into who to properly manage this case/pointers on how to make this type of situation more fluid/vivid for him and myself.

      1st Order:
      Male, 41yr
      S/X Location: a) post neck, b) base of skull, c) mid back mid-line that goes out to ribs(below shoulder blades) {T7-10} d) lower back (currently not being treated for this)
      S/X Quality: a) achy, b) Throbbing/tension does get tingling at times c) deep/achy occasional burning
      S/X Intensity: Avg: 5/10, Worst 8/10 never 0/10 Best: 4/10 wakes up multi. times a night bc of the deep pressure/ache
      P+: Laying down (supine/prone) sitting >20min, Standing >20min
      P-: N/A (tries advil, massage, PT ect)

      2nd Order: H/A started 1/2019, Moderate stress level (hes a teacher), DX with early RA 8/2017, blood showed increased C-Reactive protein.
      MRI: Cervical Spine 2/2019
      – C1-2 Mild Degenerative changes at the anterior atlanto dental joint
      – C3-4 Mild circumferential disc.
      – C4-5 Mild circumferential disc approaches but efface the thecal sac.
      – C5-6 Very mild circumferential disc. Small vertebral body Osteophytes are present
      – C6-7, C7-T1 –> Clean
      -T5-6 Moderate circumferential disc effacing the right aspect of the thecal sac
      – T8-9 mild circumferential disc w/ left paracentral contributing to narrowing of neural foramina and possible nerve impingement.
      – T6-7 anterior disc
      – Mild circumferential disc T4-5

      UCF- 16 mild pull mid-line C0-4
      CF – 45 moderate pull mid-line C4-T7
      CTF – 57 moderate pull mid-line C4-T7
      ROT: L- 51 Bi pull lat neck mod
      R- 66 Bi pull lat neck mod
      T-Spine Rot: L 37/67% T9-T12 sig. tightness/pull mid-line left rib cramping (sharp).
      R 43/78% T9-T12 sig. tightness/pull mid-line

      After 4 visits his UCF got to 23, and CF to 61
      He stated that after that visit this neck “was feeling better” but his mid back pain is whats really scaring him bc the pain feel deep and achy and is really intense along his left ribs. We were able to make significant changes to his thoracic rotation after 1 treatment. L 55/100 R 55/100 but the S/X remained the same.

      My questions to everyone, is should i continue to focus on his neck of his T-spine Given the pathology presented in both? Or should i completely finish with neck than go on to t-spine. Has anyone treated people with disc issues in both C and T spine and where did you start? Any and all input is greatly appreciated.

      Thanks everyone.


      Brandon Cohen DC, CSCS

        This is a communication thing to me. I don’t think it particularly matters. You just need to have a good reason and explanation for what you decide to do.

        Its not unreasonable to shift gears to the thoracic spine, unless you suspect the thoracic spine pain is more from the cervical spine, then you would certainly want to clean out CTF and rotation first.

        If you think its more thoracic than cervical now, my communication would typically go something like, “Your neck is much better than when we started, we are through 2 of the 4 motions to have a healthy neck. Your midback is more of where your pain is coming from now, so we will spend a couple of visits working directly on that before circling back to finish working on the neck.”

        Scratch that, I just read it again. Finish with the neck first. If you got him to 100% function of thoracic rotation and that sticks, you will need to unload everything tops to bots in order to take pressure off those thoracic discs.

        I would say it like that, “Last time we worked on your mid back and got a great change in range, but your symptoms did not really change. Its important that we finish the last two neck ranges of motion to take as much load off your discs in you rneck and midback as we can.”


        Jamie Hansen

          Thank you Brandon,

          After thinking about it and talking it over with Chris, while there is plenty of stuff going on in the mid back, i am going to clean up/finish his cervical. I explained this to him on Thursday para-phrasing ” its important that we finish with getting your neck as healthy as it can than we will move down to the mid back, so over the next few visits were gonna be focusing on your neck.” i often give the analogy of chopping down a tree, if theirs a problem in the middle part of the tree first we need to remove the branches on top we cant just jump to the middle bc the top affects the middle. (pt seems to get the visual)

          He seemed to understand completely.

          On the same note he does have lower back disc stuff im thinking of getting his neck and upper thoracic as good as i can than have him switch over to see chris. do you have any thoughts on this rational?

          Thanks again for responding and have a great weekend.


          Brandon Cohen DC, CSCS

            Sounds fine. You want to finish his priority before starting on something new. “Finish” likely means maintenance or near maintenance for this guy.

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