Prevalence of Serious Pathology Among Adults with Low Back Pain Presenting for Chiropractic Care: A Retrospective Chart Review of Integrated Clinics in Hong Kong

Chu, Eric Chun-Pu; Trager, Robert J.

doi:10.12659/msm.938042

Cited by 23 publications

(35 citation statements)

References 30 publications

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“…The current case is unusual in that the correct diagnosis was only reached after visiting a chiropractor, rather than a medical physician. To the best of our knowledge, reports of chiropractors identifying intraspinal tumors have only rarely been reported in the literature [ 21 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report

Chu¹,

Trager

2022

Am J Case Rep

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Patient: Female, 61-year-old Final Diagnosis: Schwannoma Symptoms: Low back pain with radiation • unsteady gait Medication: — Clinical Procedure: Laminectomy • thoracic magnetic resonance imaging Specialty: Chiropractic • Neurosurgery Objective: Rare disease Background: Sciatica, which is pain radiating along the sciatic nerve distribution, is most often caused by degenerative conditions of the lower back and rarely results from lesions of the spinal cord. This case report illustrates a patient with suspected lumbar radiculopathy, ultimately diagnosed with a thoracic schwannoma after visiting a chiropractor. Case Report: A 61-year-old woman presented to a chiropractor with progressively worsening lower back pain radiating to the right lower extremity and unsteady gait. Her symptoms began 10 years previously and she had been diagnosed by an orthopedist with lumbar disc herniation causing radiculopathy via magnetic resonance imaging (MRI) and was treated with physical therapy and diclofenac. Upon examination by the chiropractor, the patient had bilateral lower-extremity neurologic deficits, hyperreflexia, and upgoing Babinski responses. The chiropractor ordered thoracic MRI, but the patient preferred to initiate a trial of care, which was unsuccessful. After a delay imposed by cardiac bypass surgery, the patient returned to the chiropractor with worsened symptoms and underwent thoracic MRI, revealing an intraspinal mass at T9. The patient underwent laminectomy and tumor removal, with histopathology confirming a diagnosis of schwannoma. The patient gradually improved after surgery with the help of rehabilitative exercises. Conclusions: Clinicians should suspect a spinal cord lesion as a cause of sciatic pain when patients fail to improve with treatment, have a broad sensorimotor distribution unexplained by lumbar imaging findings, hyperreflexia/pathological reflexes, or other atypical findings (eg, negative neural tension tests). In such cases, MRI of the cervical and thoracic spine may be indicated.

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Section: Discussionmentioning

confidence: 99%

Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report

Chu¹,

Trager

2022

Am J Case Rep

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“…Chiropractors are portal-of-entry healthcare providers who often evaluate patients with spinal disorders. As such, chiropractors may occasionally be faced with unusual case presentations which could be harbingers of serious underlying systemic disease [7]. Therefore, early identification of metastasis is imperative not only to facilitate oncologic care but also to avoid any chiropractic treatment-related fractures among patients with compromised bone integrity [8].…”

Section: Introductionmentioning

confidence: 99%

“…Chiropractors are trained to recognize red flags (i.e., warning signs and symptoms) that may be indicative of serious pathology such as cancer. Examples of red flags include older age, trauma, or a focal neurologic deficit with disabling or progressive symptoms [7,11]. In such cases, chiropractors should order imaging and/or refer such patients for appropriate management without delay [7,11].…”

Section: Introductionmentioning

confidence: 99%

“…Examples of red flags include older age, trauma, or a focal neurologic deficit with disabling or progressive symptoms [7,11]. In such cases, chiropractors should order imaging and/or refer such patients for appropriate management without delay [7,11]. We searched the literature on January 27, 2023, via PubMed, Google Scholar, and the Index to Chiropractic Literature, using the terms "dropped head syndrome," and "chiropractor," and recent review articles [9,10,12].…”

Section: Introductionmentioning

confidence: 99%

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Spinal Metastasis Causing Dropped Head Syndrome in the Chiropractic Office: A Case Report

Chu¹,

Trager²,

Lee³

et al. 2023

Cureus

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Dropped head syndrome is a rare disorder involving an inability to hold the head upright. It may be caused by a variety of neuromuscular disorders and occasionally by pathological vertebral fractures.A 79-year-old man presented to a chiropractor with a two-year history of gradual-onset chin-on-chest posture and increased thoracic kyphosis, which had failed to respond to physical therapy. The chiropractor ordered whole spine computed tomography which revealed extensive mixed lytic and sclerotic changes and multiple thoracic compression fractures suggestive of metastasis. The chiropractor promptly referred the patient to an oncologist, who performed a biopsy confirming prostate adenocarcinoma. The patient's health deteriorated, and he expired three weeks later.This case highlights that chiropractors should be aware that patients may present to their office with symptoms related to undiagnosed cancer, such as spinal deformity and dropped head syndrome. Chiropractors should order advanced imaging when patients have red flag signs or symptoms (e.g., older age, progressive symptoms despite care) and refer to an oncologist when clinical features or testing are suggestive of metastasis.

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“…Evidence suggests that serious pathology such as cancer is uncommon in the chiropractic setting, affecting around 0.5% of patients with low back pain [ 14 ]. In one survey, United States chiropractors reported encountering a patient with undiagnosed cancer on average only once every eight years in practice [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Presumptive Prostate Cancer Presenting as Low Back Pain in the Chiropractic Office: Two Cases and Literature Review

Chu¹,

Trager²,

Lai³

et al. 2022

Cureus

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Prostate cancer is a common type of cancer in men and may metastasize to the spine and pelvis, causing back and/or radicular pain that appears to be musculoskeletal. This presents a diagnostic challenge and can be complicated by a lack of routine screening for prostate cancer.In two similar cases, elderly males (ages 78 and 82) with no known history of cancer and no previous prostate-specific antigen screening presented to a chiropractor with chronic, worsening radiating low back pain. In each case, a previous provider obtained radiographs and ascribed symptoms to a non-cancerous etiology (i.e., lumbar spondylosis, osteoporotic compression fracture), treated with nonsteroidal antiinflammatory medications and physiotherapy. Given each patient's progressive worsening and neurologic deficits, the chiropractor ordered lumbar magnetic resonance imaging, revealing potential spinal metastasis. The chiropractor referred each patient to an oncologist who performed additional testing, making a presumptive diagnosis of prostate cancer. A literature review identified seven cases of previously undiagnosed prostate cancer presenting to a chiropractor. Including the current cases, patients were often older, presenting with thoracolumbar pain caused by spine or pelvic metastasis.The current cases and literature review illustrate that men with undiagnosed metastasis from prostate cancer may present to chiropractors complaining of spinal pain. Chiropractors should be aware of red flags warranting imaging such as older age and new or progressive symptoms and should refer patients to an oncologist when suspecting prostate cancer.

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Prevalence of Serious Pathology Among Adults with Low Back Pain Presenting for Chiropractic Care: A Retrospective Chart Review of Integrated Clinics in Hong Kong

Cited by 23 publications

References 30 publications

Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report

Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report

Spinal Metastasis Causing Dropped Head Syndrome in the Chiropractic Office: A Case Report

Presumptive Prostate Cancer Presenting as Low Back Pain in the Chiropractic Office: Two Cases and Literature Review

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