BUTTRESSING OF THE SACRUM

Case History

This 70-year-old male patient complains of lower back and right hip pain, measured at 3/10. Occasionally, the patient experiences symptoms of radiculopathy down the right leg.

Radiographic Findings

Observe the sclerotic appearance of the dome of the sacral promontory. This sclerotic appearance is unrelated in osteoblastic activity from neoplasm but rather a stress related phenomenon. The disc space narrowing at the L5/S1 level is advanced placing a significant amount of stress upon the anterior sacral promontory, which allows subchondral degenerative sclerosis to occur. Notice, there is a double degenerative spondylolisthesis with a slight anterior displacement at L3 upon L4 and L5 upon the sacrum. Degenerative spondylolisthesis has been defined by Hadley as spondylolisthesis with an intact neural arch. Degenerative spondylolisthesis is seen most frequently in females over the age of 40 and often obese. This follows the “3 F signs” of degenerative spondylolisthesis: Females over Forty and Fat (apology offered). Note also, mild atherosclerosis present in the abdominal aorta.

Reference

Yochum and Rowe, Essentials of Skeletal Radiology, Masqueraders of Musculoskeletal Disease, Chapter 18 Lippincott, Williams and Wilkins, 2005.

DOUBLE DEGENERATIVE SPONDYLOLISTHESIS

Case History

A 53 year old female patient with bilateral low back pain and radiculopathy extending down the left leg to the great toe.

Radiographic Findings

Observe the bilateral sclerosis and hypertrophy of the facets at the L4/5 and L5/S1 levels. There is a minimal anterolisthesis of L4 upon L5 and a greater degree of anterolisthesis of L5 upon the sacrum without pars defects. This represents a pseudo or degenerative spondylolisthesis and is seen most frequently in female patients but certainly occurs in male patients.

Degenerative spondylolisthesis with an intact neural arch was referred to by Junghanns as pseudo spondylolisthesis differentiating it from those with a neural arch defect. Degenerative spondylolisthesis is approximately ten times more common at L4 than seen at the L3 or L5 vertebrae and no greater than 25% anterior displacement of the L4 vertebral body occurs, with the majority involving only 10 to 15% displacement. It is six times more common in females 60 years of age or older, compared with males of the same age. It is rare in persons under the age of 50. It is three times more common in African Americans than in White with no adequate explanation to these sexual and racial disparities. Finally, degenerative spondylolisthesis is four times more likely to be found in association with a sacralized fifth lumbar vertebrae.

There is a significant association of patients with degenerative spondylolisthesis most likely at the L4 level with spinal stenosis and/or back and leg pain. Most patients with degenerative spondylolisthesis do not have leg pain, they have pain primarily in the low back and maybe in the upper buttocks. Patients with leg pain extending below the knee who also have degenerative pseudo spondylolisthesis may have an associated giant synovial cyst compressing nerve roots within the spinal canal. Synovial cysts are a complication of advanced degenerative facet arthrosis and have been referred to as the “Baker’s cyst of the spine”. Any patient with degenerative spondylolisthesis who does not respond to conservative chiropractic treatment within a reasonable period of time and has symptoms of sciatica should have an MRI scan to rule out the possibility of a giant synovial cyst.

References

Schmorl, G and Junghanns, H., The Human Spine in Health and Disease, Ed. 2, New York, Grune and Stratton, 1971.

McNab, I, Spondylolisthesis with an Intact Neural Arch; so-called Pseudo-Spondylolisthesis, J. Bone. Joint. Surg (Br) 32; 325, 1950.

Yochum Tr, et al: Reactive Sclerosis of a Pedicle Due to Unilateral Spondylolysis-A Case Study ACA J Chiro, Radiology Corner, RC September 1980.

Yochum Tr, Yochum and Rowe, LJ, Essentials of Skeletal Radiology, Chapter 5 entitled The Natural History of Spondylolysis and Spondylolisthesis, 3rd ed, Lippincott, Williams and Wilkins, 2005.

Opinion: Chiropractic gains show changing face of comprehensive health care

E.D. Terzi and Terry R. Yochum

Chiropractic clinics have become ‘wellness centers’ offering comprehensive health care with massage therapy, health diet coaching and more

For decades, the chiropractor has been an under-appreciated medical professional when it comes to comprehensive health care, looked upon as bone popper whose value has always been suspect by many in the medical community. A recent study by Chiropractic Economics indicated that a chiropractor saw 40% more patients than a family MD, however made 40% less in annual income.

That same study also showed a change in 2021 driven by the patients, not the medical profession. The family doctor saw their income decline by 50% as a result of less patients seen; chiropractors saw a 10% increase in patients and a 20% increase in office revenue.

So, what is really happening and why are things changing?

A dramatic year

The year 2020 was dramatic for everyone and the “normal” was redefined to fit the changes in how patients want to be treated for their illness, and how patients see their health.

Many medical offices shifted to a telemedicine model while most chiropractors continued to see patients in their offices. Chiropractors of 2021 now do more than just adjustments; they have become “wellness centers” offering comprehensive health care with massage therapy, health diet coaching, weight control programs, pain management, acupuncture, diagnostic x-ray services and even sleep aid support products.

Patients find their needs met without a visit to their family MD. Often, a patient may make an appointment in days rather than waiting weeks.

Holistic health and comprehensive health care over prescriptions

The family MD has become someone who basically prescribes medication, manages the side effects, orders lab blood work and reviews the results with a specialist’s referral.

Meanwhile, the chiropractor has been talking to their patients and learning about their body health and attending webinars by radiology luminaries where they learn how to look at digital X-rays, ultrasound and MRI exams which allow them to treat patients beyond the subluxation. In 2021, chiropractors are becoming the “Family Wellness Chiropractic Doctor,” someone a patient can visit, depending on their malady, for comprehensive health care before they decide to make an appointment with their family medical doctor (MD).

Health care in 2021 and beyond

Both health care professionals are essential and are important parts of how Americans are looking at their health care going into and beyond 2021. This is evident by the facts shown in the Chiropractic Economics report indicating that the number of patient visits to chiropractors in 2021 grew by over 25 million, and today chiropractors nationwide are seeing over 250 million visits annually.

E.D. Terzi is the marketing director at Rayence & My Vet Inc., and Terry R. Yochum is a doctor of chiropractic, DACBR, Fellow, and ACCR.

Find the original article at https://www.chiroeco.com/comprehensive-health-care/