Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple level anterior cervical discectomy and fusion: a case report.
STUDY DESIGN Case report. BACKGROUND Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. CASE DESCRIPTION The patient was a 46 year old woman referred to outpatient physical therapy 2 months following multiple level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6 week episode of care. OUTCOMES Immediate reductions in cervical region pain (mean SD, 2.0 1.1) and headache (2.0 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16% with an associated global rating of change scale score of +7 "a very great deal better" DISCUSSION This case report describes the immediate and short term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.
The Journal of orthopaedic and sports physical therapy