Degenerative Cervical Myelopathy in a Veteran Chiropractic Patient Referred for Lumbar Radicular Pain: A Case Report.

Objective: The purpose of this report is to describe a patient with progressive neurological signs during a trial of chiropractic care for lumbar radicular pain. Clinical Features: A 72-year-old male US Veteran presented for chiropractic care with left lower extremity pain and numbness and tingling in both hands and feet. The patient's comorbidities included stage IV b-cell lymphocytic leukemia currently in remission, scleroderma, diabetes mellitus with previously diagnosed peripheral neuropathy, hemolytic anemia, and osteoporosis from long-term corticosteroid use. Initial evaluation was unremarkable for neurological findings, a re-evaluation revealed new signs suggestive of myelopathy including brisk patellar reflexes and a unilateral Hoffman's sign. Lumbar spine radiographs were requested and demonstrated moderate, diffuse spine-related degenerative changes. Intervention and Outcome: After 5 sessions of chiropractic flexion-distraction manipulation to the lumbar spine, soft-tissue therapy, and sciatic nerve mobilization exercises, the patient improved. However, at re-evaluation progressive neurological findings warranted primary care coordination for the request of advanced imaging due to suspicion of cervical myelopathy. A cervical MRI revealed severe cervical spinal stenosis with impingement upon the cervical cord at C3-C4. A neurosurgical consult was placed by the requesting physician for surgical consideration. Conclusion: This case highlights the challenges associated with early signs of degenerative cervical myelopathy and its variable presentation. It highlights the importance of performing routine re-evaluations when managing multimorbid neuromusculoskeletal conditions and how signs of chronic conditions, such as degenerative cervical myelopathy, may rapidly manifest.