Salik Emsal, Donat Ali, Ağaoğlu Mustafa Hulisi
Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey.
J Chiropr Med. 2020 Dec;19(4):249-259. doi: 10.1016/j.jcm.2020.01.002. Epub 2021 Jan 22.
The objective of the present study objective was to describe adjacent segment disease (ASD) from a chiropractic management prospective and subsequently to stimulate further research into the chiropractic therapeutic effects on such cases and to contribute to chiropractic literature.
A 44-year-old woman had a history of lumbar stabilization revision operation by pedicle screw fixation for spondylolisthesis. Her intractable back pain episodes, which were diagnosed as ASD, began shortly after this surgery. At presentation, she was taking pregabalin 75 mg 2 times a day for postoperative neuropathic pain without any pain relief. Clinical testing revealed myofascial tender points reproducing the pain.
After taking the case history and performing a physical examination, the patient was managed with chiropractic Nimmo receptor-tonus technique in combination with McKenzie exercises. Nimmo was applied by manually pressing on clinically relevant points for 5 to 15 seconds in 11 visits over 3 weeks. The patient by herself did McKenzie exercises 5 to 10 times a day for 10 to 12 repetitions over 2 months. After 3 weeks of therapy, visual analog scale and Oswestry Disability Index scores were improved. Furthermore, because of the amelioration of the patient's symptoms, her neurosurgeon successfully discontinued pregabalin 75 mg 2 times a day without negative consequences to care.
As far as the authors are aware, there is currently no published case of ASD care in chiropractic literature. Our rehabilitative management received a favorable response. It can be hypothesized that it offers a perspective that informs improved patient care.
本研究的目的是从整脊治疗的角度描述相邻节段疾病（ASD），进而推动对整脊疗法对此类病例治疗效果的进一步研究，并为整脊医学文献做出贡献。
一名44岁女性有因腰椎滑脱行椎弓根螺钉固定腰椎稳定翻修手术史。她在该手术后不久开始出现被诊断为ASD的顽固性背痛发作。就诊时，她每天服用2次75毫克普瑞巴林以缓解术后神经性疼痛，但疼痛未得到任何缓解。临床检查发现肌筋膜压痛点可引发疼痛。
在采集病史并进行体格检查后，对该患者采用整脊尼莫受体张力技术并结合麦肯齐疗法进行治疗。在3周内进行了11次就诊，通过手动按压临床相关穴位5至15秒来应用尼莫技术。患者在2个月内每天自行进行5至10次麦肯齐疗法，每次重复10至12次。治疗3周后，视觉模拟评分和奥斯维斯特功能障碍指数评分有所改善。此外，由于患者症状改善，她的神经外科医生成功停用了每天2次75毫克的普瑞巴林，且对治疗没有产生负面影响。
据作者所知，目前整脊医学文献中尚无关于ASD治疗的已发表病例。我们的康复治疗管理取得了良好的效果。可以推测，它提供了一种有助于改善患者护理的观点。
