RELIEF OF NEUROLOGICAL SYMPTOMS SECONDARY TO SURGICAL REMOVAL OF THORACIC ASTROCYTOMA BY CATEGORY 1 BLOCK PLACEMENT: A CASE REPORTWILLIAM J. BORO, DC, CC, DICS

INTRODUCTION

PURPOSE OF THIS PRESENTATION

To describe the clinical course, treatment, and positive response of a female patient suffering from symptoms secondary to postsurgical laminectomy and resection of a thoracic pilocytic astrocytoma.

The application of Sacro-Occipital Technique™ Category I blocks immediately and repeatedly relieved severe, constant paresthesia, a sense of buzzing, in her lower extremities.

Provide a theoretical understanding of why Category I block placement was effective in this case.

WHAT IS A PILOCYTIC ASTROCYTOMA?

AKA Juvenile pilocytic astrocytoma Most common CNS neoplasm of

childhood Cases over the age of 30 are rare Low grade, localized and slow-

growing Considered benign with a

favorable prognosisIntramedullary

Diseases of the spine and spinal cord,

p. 225

Intradural extramedulla

ryDiseases of the spine and spinal

cord, p. 209

Epiduralwww.stritch.luc.edu

PATIENT HISTORY

PATIENT INFORMATION

5’5”, 115 pound, 28 year old nulliparous female Two weeks of upper back pain at night Electric shocks down left side when moving head Foot jerked off the gas pedal when turning head

to change lanes Surgical removal of 4” long thoracic pilocytic

astrocytoma with T4-T7 laminectomy 10% of tumor was left in situ Post surgery unable to walk for 2 weeks

PATIENT SYMPTOMS POST-LAMINECTOMY PRIOR TO CHIROPRACTIC TREATMENT

Constant low back pain & rib instability

Neuropathy Pain and numbness in both legs Pain and cramps in both feet Paresthesias (e.g.,Buzzing in legs) Difficulty with activities

Pushing or getting in and out of car Sitting at a table Sexual activity

Visceral dysfunction Constipation with inability to

defecate without pharmaceutical intervention

Projectile vomiting No menstrual periods Vaginal numbness

COMMON POST-SURGICAL OUTCOMES Total recovery time from 3-12 months Some patients develop new

numbness or tingling pain which sometimes is worse than the pain before surgery

From spinalcordtumor.org

In 2014 study of 69 patients, neurological states Improved in 23.2% Unchanged in 68.1% Aggravated in 8.7%

Functional outcomes Good in 75.4% Fair in 14.5% Poor in 10.1%

From Neurological Outcome after Surgical Treatment of ISCT (Lee, Cho, Kwon)

TREATMENT

CHIROPRACTIC PHYSICAL THERAPY

Cranium Full spine Extremities and ribs Soft tissue release techniques

around the incision Visceral adjustments SOT Category III, II and I

blocking

Aquatherapy Physical Therapy

CATEGORY I BLOCKING RESULTS

There was an immediate (within 5 minutes) cessation of the “buzzing” in her legs

Cessation of buzzing lasted up to 12 hours Patient took blocks home and has been able to do more activities of

daily living with less buzzing

DISCUSSION

DURAL ATTACHMENTS The dura attaches firmly to the cranium and the sacrum There are also attachments in the cervical and lumbar spine

ADVERSE MECHANICAL TENSION IN THE CENTRAL NERVOUS SYSTEM

Alf Breig states that if tension is created in the pons cord tract it can result in symptoms of neurological deficit or excitation and hyper- or hypo-function of various organs

“…symptoms from a localized lesion may be relieved to a greater or lesser extent when the pons cord tract is rendered slack.”

WHAT CAUSES COMPRESSION TINGLING?

Mechanical deformation Oxygen lack Accumulation of local metabolites Lowering of threshold to stimulation of

the nerve by any of the above causes Combination of these causes

Pins & Needles, Weddell, 1946

WHAT DOES CATEGORY I BLOCKING ACCOMPLISH?

Category I

Corrects rotational malposition of pelvis Relaxes paraspinal musculature Calms proprioceptors Affects spinal dural tension and traction on spinal nerves Removes dural torque Aligns dural ports Frees minor dural port constrictions

SO HOW DOES IT WORK?

Tensions, torsions and deformations created by spinal and dural scar tissue cause buzzing and increased sensitivity around the laminectomy scar

Blocking: Releases cord tension and torsion Creates better CSF fluid circulation Increases removal of waste metabolites Improves oxygenation

Category I blocking creates a relative flexion/extension release of the sacrum

CSF CHANGES AFTER BLOCKINGCOURTESY OF VINCENT ESPOSITO, DC, CSCP

CONCLUSION

REDUCTION OF SYMPTOMS

More feeling in feet Diminished low back pain Increased rib stability Marked improvement in

balance No longer needing a walker Relief of buzzing paresthesia

within 5 minutes using blocks

Reduced need of medications Improved bowel function Menstrual periods began again

CONCLUSION It appears that there may be a subset of patients suffering from paresthesia

secondary to post surgical spinal cord tumor removal and laminectomy who will respond to the application of Category I blocking.

This patient’s response to care suggests a potential boon to others who suffer from this horrible condition.

Caution about generalizing these results to other patients is advised. Condition has improved, the improvement is sustained, and that when

symptoms recur, they respond quickly to this application is suggestive that this therapy is the cause of improvement.

It is hoped that this study will generate greater interdisciplinary interest and cooperation so that patients suffering with this condition may have an alternate choice of treatment with reduced need of prescription medications.