Expert: Gerald Anzalone, D.C. - 9/20/2008

Question
Hello - I am inquiring what is the protocol for Chiropractors when a patient comes in with the mris and exrays and tells the Dr. that he is fused at C3-C4?

First our insurance sent him to Chiropractor because he was supposed to do P.T.

He looks at the mris and says oh I can fix you up in about 6 sessions.  He proceeds to Crack my husband's neck and my husband leaves and by the time he gets home he has a massive headache and his neck is hurting a lot worse than when he came in.



He refused to return and started P. T.   Saw a Neurologist and a Pain Specialist, both of them were shocked to learn what the Chiropractor did.



It's been about 22 sessions with P. T. and time is running out, we only are allowed 31 sessions.  He is now having problems with his lower back due to his compensating with his neck.





Inquiring wife wants to know.  



Dana Marsolino  

Answer
Dana,

In general, manipulation of the cervical spine is contra-indicated at the level of fusion of vertebrae. 'Claw osteophytes', or bone spurs, may develop in the front margins of vertebrae, eventually causing a fusion of those segments, and this is not a process that is amenable to manipulation, nor can it be reversed with manipulation.

However, a skilled practitioner may, if clinically indicated, manipulate segments above or below the areas of fusion. Regardless, manipulation, as in any other therapeutic intervention, may produce some undesired effects in certain cases, and if these are experienced, the practitioner should cease using manipulation and, depending upon the patient and the condition, try an alternative therapeutic approach. Research has shown that mobilization (a manual therapeutic procedure that typically uses less speed and depth in moving joints) can be just as effective as manipulation; again, mobilization might be used either above or below an area of fusion, not at the level of fusion.

I hope that this answers your question.