Concluded Case

Blocked Vertra C4-5

New case 44 yr ,f, Developed back pain with radiation to both lower limbs since 2 months. She was evaluated at Ayurvedic center where she received treatment an IP. Whole spine massaging done for 21 days . Low back pain became better .After the 1st week of spinal massaging, she developed pain in the neck with radiation of pain to both shoulders. After 21 days also the pain is persisting and infact she has more pain and hence attended the OPD. On exam her vitals stable. Neck movements restricted in all directions . Myalgia noted around the neck . Motor system normal power with intact DTRs and sensations. Diagnosis & management?.

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Concluded answer
Thanks for all answeres. MRI cervical spine ●Cspine straightening. ● C4 & C5 verebral bodies appears fused with loss of intervening disc spaces.Posterior elements are not fused and splaying noted in between C4- C5 spinous process- suggestive of blocked vertebra. Anterior wedge compression in C4 vertebra.Anterior & posterior Ht reduction in C5 vertebra. Mild kyphosis at this level resulting in complete obliteration of anterior thecal space & narrowing of spinal canal. ● Mild disc bulge at C5-6 and C7- T1 with partial obliteration of anterior thecal space. Patient was admitted in view of severe pain & became better with Pregabalin .During the hospital stay ,our spinal surgeon was also evaluated. Suggested surgery at an elective date. Dr Riju ,as per your request, I am posting the plain X Ray's also now separately.
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Thanks Nihar. I was actually pointing out that massaging spine for a prolonged periods, as done by the Ayurveda centers in question was detrimental to the particular patient, as we see here. There are lots of such fraud centers in every corner of our country who draws people with catchy advertisements, and cheat them by inexperienced hands.
I am totally agree with you sir. These are the reasons why till date patients prefer to go for some magical treatment unless and until they make the conditions severe. And come with chronic stage or irreversible stage for cure to us. Awareness still not reached. It will again take some decades to show them true light. Thank you sir.
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physiotherapist is an integral part of the team..but they are not and cannot act as stand alone doctor.. they should work as per guidance and collaboration with a spine clinician.. daily i see worsened patients who have approached a physiotberapist and he/she diagnoses, treats and even prescribes medicines on his own?!! it is illegal.. i see big ads for luring people with promise to avoid surgery promotimg some spine gadget, or oil, or exercise brand and what not... by physioyherapists and ayurveda practitioners.. and they take advantage of human nature of desire to avoid surgery.. ?! and they keep worsening...ultimately when they land up for surgery, the nerves are bad, muscles have wasted, joints are worn out and the result is poor.. its a big racket... i appeal to all physiotherapist and ayurveda and homeopaths etc .to work in collaboration and guidance with spine clinicians.. we dont operate where not needed.. but you all prevent those patients needing essential surgery from reaching us in time and that is a disservice to the society for personal gains.. in fact, i appeal to all allied sciences that you all should encourage these patients to consult us, encourge to undergo surgery if deemed essential as per our judgement .. during the same you are going to get postoperative phhsio care which is equally emohasized and so your financial interests will be satisfied.. but ethically..which is more valuable
Thanks for all answeres. MRI cervical spine ●Cspine straightening. ● C4 & C5 verebral bodies appears fused with loss of intervening disc spaces.Posterior elements are not fused and splaying noted in between C4- C5 spinous process- suggestive of blocked vertebra. Anterior wedge compression in C4 vertebra.Anterior & posterior Ht reduction in C5 vertebra. Mild kyphosis at this level resulting in complete obliteration of anterior thecal space & narrowing of spinal canal. ● Mild disc bulge at C5-6 and C7- T1 with partial obliteration of anterior thecal space. Patient was admitted in view of severe pain & became better with Pregabalin .During the hospital stay ,our spinal surgeon was also evaluated. Suggested surgery at an elective date. Dr Riju ,as per your request, I am posting the plain X Ray's also now separately.
Respected madam. As mentioned there were no problem before at cervical region and no radiation to shoulder before the treatment she has taken for 21days. These are D/D 1.All neck movements restricted.. May be due to gross spasm of neck muscles which is a protective phenomenon to sudden movements or unaccustomed muscular activities. 2. Locked facet 3. Trapezitis, causing radiation to shoulder 4. Protective paraspinal muscle spasms following deep tissue massage. 5. Triggered Myofacial pain syndrome after the massage. SOMETIMES THE PROBLEMS ARE SIMPLE AND USUALLY RELIEVED BY POSTURAL CORRECTION OR STOPPING THE NEW TREATMENT PROTOCOL. THE SYMPTOMS DON'T SHOW ANY NEUROLOGICAL INVOLVEMENT EXCEPT RADIATION. NORMAL MUSCULAR SPASM EVEN CAN CAUSE RADIATION. Thank you.
Look like a congenital anomaly at C4 level like a hemivertebra Confirmation by history and radiologist report Indentation of cervical cord Neurosurgery evaluation to assess benefits of surgery Please post plain xrays of cervical spine
Better to have a ct cervical spine with 3d reconstruction. Once we have an idea on bony anatomy. We can try cervical traction .
Thank you doctor
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Compressive myeloradiculopathy (iatrogenic) Is Ayurveda Physiotherapy all about massaging?
Respected sir. Hope you are doing well. No doubt massage is included in physiotherapy treatment protocol but physiotherapy is not all about massage. In many neurological conditions we both perform team work for betterment of the patient. Starting from CP child to PIVD patients we Combinedly work for fruitful results. Massage therapy, hydrotherapy, electrotherapy, actinotherapy, manual therapy, exercise therapy are conventional methods of physiotherapy treatment. Nowadays advanced methods are, dry needling therapy, NDT, Sensory integration therapy, isokinetic Rehabilitation regimens, etc. It is obvious that we treat patient without medication but with therapy. And physiotherapy is not all about massage. Thank you sir
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MRI doesnt show root compression.. brace and conservstion
I agree
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