Cervical Spine

	DIAGNOSIS & TREATMENT Cervical spine pain conditions grow in their incidence in this modern world of cars, computers and stress. Cox® Technic for cervical spine pain and resultant arm pain is gentle, safe and effective.
	GOALS Cox® Technic offers relief for your neck and related arm pain as quickly as possible, but it adheres to the Rule of 50%, seeking at least 50% relief in the first 30 days of care. Some patients report relief in one treatment, some in 4, some in 10 or more. Know that your doctor will monitor your condition carefully.
pain                    no pain
	DOCUMENTATION Cox® Technic evidence-based, non-surgical protocols are outlined in a published textbook, Neck, Upper Back, Shoulder and Arm Pain. Several case reports and prospective case reviews have been published. An initial clinical comparison trial has been  completed. A biomechanical study is recently completed by researchers at Palmer Research Center, Loyola Stritch School of Medicine and the Hines VA Hospital. Data are being analyzed. A clinical comparison trial is underway at Palmer Research Center. Many journal articles and case reports (choose "case reports" then "cervical spine" have been published documenting the relief Cox® Technic Flexion Distraction offers.
	TREATMENT & RESULTS Often, within just a visit or two, pain is diminished without drugs or other more invasive procedures. The cervical spine is delicately moved into long-y-axis by a doctor's hand. It is controlled and monitored at all times by the attending physician. Individual segments are treated to address the pain causing issue. Foramen magnum pump may be applied to the full spine, but all is done under careful doctor supervision to produce the best clinical results possible.

A 60 year old male presented with complaints of pain and limited motion in his neck, with pain and weakness in his left shoulder and arm. These symptoms began after a fall approximately 4 months prior. His previous allopathic care included medication and physical/occupational therapy, which provided no significant relief. Cervical plain film radiographs demonstrated degenerative changes and the magnetic resonance imaging revealed multilevel central stenosis. The patient was treated with flexion-distraction manipulation, which provided significant relief of his subjective and objective findings. Cervical stenosis with resultant radicular and neurological complaints may be difficult to manage with both conventional allopathic and chiropractic treatment. Flexion distraction manipulative therapy may be an effective treatment option for these often-difficult cases.

Objective The purpose of this report was to describe the use of Cox flexion distraction decompression manipulation on a patient with radiculopathy from a C6/C7 disc herniation. Clinical Features A 33-year-old man complained of severe neck pain and spasms, pain radiating down his left arm and upper back, and associated numbness in his fingers. Cervical spine plain film radiographs showed mild C6/C7 osseous degenerative changes. Cervical magnetic resonance imaging revealed a moderate-sized left posterolateral disc herniation at C6/C7 causing severe foraminal stenosis. Intervention and Outcome Treatment consisted of Cox flexion distraction decompression manipulation and adjunctive physiotherapy modalities. The patient was treated a total of 15 times over a period of 10 weeks. Subjective findings using a pain scale and objective examination findings supported a good clinical outcome. At 2-year follow-up, subjective and objective findings remained stable. Conclusion This study reports Cox flexion distraction decompression manipulation and physiotherapy modalities showed good subjective and objective clinical outcomes for this patient.

Cox® Distraction procedures for the cervical spine and thoracic spine are a natural outgrowth of its application to the low back. This technical overview of Cox® Distraction procedures for the cervical and thoracic spine is intended to introduce this form of care for patients intolerant of classic rotatory thrust techniques due to such anatomical and pathological findings as degenerative disc disease, vertebral artery syndrome, disc herniation, blocked vertebra, occipitalization, scoliosis, other congenital defects, as well as for patients who just cannot be high velocity adjusted.

A 34-year-old female presented to a chiropractic office with severe, unremitting, cervical, shoulder, and arm pain of several months' duration. Past medical history, clinical evaluation, and plain-film radiographs revealed findings consistent with Klippel-Feil syndrome. The radiographs revealed a C2/3 block vertebrae, atlas assimilation, and premature degenerative changes consistent with the syndrome. Treatment consisted of cervical flexion-distraction manipulation and adjunctive therapies. This patient felt relief after the first treatment and experienced a complete resolution of her symptoms after eight treatments performed over a period of 2 months. Klippel-Feil syndrome is an anatomical entity that results in premature cervical degenerative changes, which may cause radiculopathy. Flexion-distraction manipulation performed to the cervical spine is a relatively new clinical procedure, which shows great promise for the treatment of cervical radiculopathy.

Background: Although flexion distraction performed to the lumbar spine is commonly utilized and documented as effective, flexion distraction manipulation performed to the cervical spine has not been adequately studied.
Subjective: To objectively quantify data from the Visual Analogue Scale (VAS) to support the clinical judgment exercised for the use of flexion distraction manipulation to treat cervical radiculopathy.
Design and setting: A retrospective analysis of the files of 39 patients from a private chiropractic clinic that met diagnostic criteria for inclusion. All patients were diagnosed with cervical radiculopathy and treated by a single practitioner with flexion distraction manipulation and some form of adjunctive physical medicine modality.
Main outcome measures: The VAS was used to objectively quantify pain. Of the 39 files reviewed, 22 contained an initial and posttreatment VAS score and were therefore utilized in this study.
Results: This study revealed a statistically significant reduction in pain as quantified by visual analogue scores. The mean number of treatments required was 13.2 ± 8.2, with a range of 6 to 37. Only 3 persons required more treatments than the mean plus 1 standard deviation.
Conclusion: The results of this study show promise for chiropractic and manual therapy techniques such as flexion distraction, as well as demonstrating that other, larger research studies must be performed for cervical radiculopathy.

Objective: To describe the safety and potential therapeutic benefit of spinal manipulation postepidural injection in the nonsurgical treatment of patients with cervical and lumbar radiculopathy.
Methods: The study design was a retrospective review of outcomes of 20 cervical and 60 lumbar radiculopathy patients who underwent spinal manipulation postepidural injection in a hospital setting. Patients received either fluoroscopically guided or computed tomography (CT)–guided epidural injection of a combination of lidocaine and Depo-Medrol. The manual therapy consisted of an immediate postepidural application of flexion distraction mobilization and then high-velocity, low-amplitude spinal manipulation to the affected spinal regions. Outcome criteria were empirically defined as significant improvement, temporary improvement, or no change. The minimum follow-up time for all patients was 1 year.
Results: There were no complications associated with spinal manipulation, whereas 3 complications associated with the epidural injection procedure were noted. Of lumbar spine patients, 36.67% (n = 22) noted significant improvement, 41.67% (n = 25) experienced temporary improvement, and 21.67% (n = 13) reported no change. Of the patients undergoing spinal manipulation after cervical epidural injection, 50% (n = 10) noted significant improvement, 30% (n = 6) experienced temporary improvement, whereas 20% (n = 4) exhibited no change.
Conclusions: These data suggest that spinal manipulation post-epidural injection is a safe nonsurgical procedure to use in the treatment of the patient with radiculopathy of spinal origin. This is also the first report of the use of spinal manipulation postepidural injection in the cervical spine.

Objective: To discuss the non-surgical treatment of a cervical disk herniation with flexion distraction manipulation. Clinical Features: A case study of cervical disk syndrome with radicular symptoms is presented. Magnetic resonance imaging revealed a large C5-C6 disk herniation. Degenerative changes at the affected level were demonstrated on cervical spine plain film radiographs.
Intervention and Outcome: The patient received treatment in the form of flexion distraction manipulation and adjunctive therapies. A complete resolution of the patient's subjective complaints was achieved.
Conclusion: Flexion distraction has been a technique associated with musculoskeletal conditions of the lumbar spine. Flexion distraction applied to the cervical spine might be an effective therapy in the treatment of cervical disk herniations. Although further controlled studies are needed, treatment of cervical disk syndromes with flexion distraction might be a viable form of conservative care.

80% of cervical and lumbar spine disc herniations helped by flexion distraction adjustment. 63% showed MRI reduction in size