Case 2 Details

• 42 year old psychologist
• Started Chiropractic care 03/03/16
• Complaining of on going neck, upper thoracic pain of about a month duration
• Pain increased by sitting and computer use
• Initial Pain resolved by 03/28/16 after 6 visits and then started monthly treatments with good results and minimal reported pain
• MRI of the cervical spine was ordered

• On 10/21/2016 (7 months after first visit) patient reported new increased pain in the cervical spine.
• Pain was reported as severe, shooting, sharp and stabbing rated 9/10
• Reported recent cold with lots of coughing and sneezing a week prior
• Patient further reported new pain shooting down to the left shoulder and left arm
• Worse with sitting for long period of time
• Better with Ice, laying down

• Prescribed muscle relaxant (Flexeril) 10 mg po qhs and hydrocodone 5-325 mg po tid prn.
• Second Cervical Epidural Steroid Injection 12/13/2016 combined with continued chiropractic therapy > 99% relief of neck and left arm pain
• Emphasized importance of ongoing adjustments and physical therapy
• No follow up with Pain needed
• Keeps seeing Dr. Stephens
• Happy camper
• No PCP > Spine Surgeon > Surgery > More problems down the road
• No High Dose Narcotics > Dependence > Addiction > Impact of life/ Job
• What if Patient’s left arm pain improved but she continued to have neck Pain?

Spine Structures

Spine Structures​

Disk Degeneration (Different Phases)

• 57 year old Male originally from NJ currently resident of McKinney
• 5 year history of Low back, Left buttock and occasional Left leg pain
• Patient had tried:
  Chiropractic care on and off for about 5 years > Short term relief​
  NSAIDs, Tylenol, Low Dose Narcotics > Minimal Relief
  Massage therapy >Minimal Relief
  Physical Therapy > Minimal Relief
  Series of three Epidural Steroid Injection by another provider in Allen > Minimal Relief
• ​Patient saw a spine surgeon in Allen who did not recommend surgery as the MRI “did not look that bad”

• First visit 10/28/2016
• Normal neurological exam
• Positive straight leg raise test at 15 degrees on the left side.

Old Approach: Open Laminectomy & Discectomy

Disc Herniations Unresponsive to Injections

• Patient reported 70% relief only for a day relief of pain from Left L5-S1 transforaminal epidural steroid injection 11/01/2016
• He reported No improvement upon follow up on 11/17/2016

New Approach: Ultra Minimally Invasive

Advantages

Less

• Trauma to muscles, ligaments
• Bone resection>Iatrogenic Instability>Need for instrumented fusion
• Epidural fibrosis
• Bleeding
• Faster recovery/ Less Postop Pain
• Doesn’t “burn any bridges” for future revisio
• Could be done without GA in high risk patients

New Approach: Minimally Invasive

Laminectomy > Instability

Instrumentation for Stability

Later down the Road...

New Approach: Ultra Minimally Invasive

New Approach: Ultra Minimally Invasive

• Patient underwent Left L5-S1 endoscopic discectomy and annuloplasty on 11/29/2016
• Upon follow up on 01/06/2017 patient reported 70% relief of his pain
• “The best he has felt in 5 years”
• Patient was released back to follow up with his Chiropractor to continue adjustments and therapy
• Would like us to now focus on his shoulder
• What if he wants the remaining back pain gone?

Thermal Annuloplasty Endoscopic