X-Rays and "It’s Just a Stiff Neck Doc!"

X-rays are a diagnostic tool which most chiropractors include as an important part of determining the appropriateness and safety of chiropractic care.  I have written about x-rays before, but a colleague’s Facebook post along with the interesting history of a recent patient of our office returns me to blog about this subject of x-rays once again.
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X-rays and Facebook

The Facebook post stated simply “I can’t begin to tell you how many times I’ve been asked: Do I really need x-rays? It’s just a stiff neck!” Sometimes it is MORE THAN A STIFF NECK!  Immediate referral to oncologist!
He included this image:

The patient came into this chiropractor’s office complaining of a simple stiff neck.  The history and examination findings were significant enough for this chiropractor to include x-rays in his work up, and the resulting x-rays revealed possible bone cancer of the 3rd cervical vertebra.  This doctor had used Facebook as a tool to illustrate to the public how important “being the doctor” was to this case.

Any chiropractic adjustment would have great potential to do harm to a patient with a bone pathology like this.  This excellent chiropractor referred the patient to an oncologist.
This case is an example of how competent  chiropractic care begins with much more than an adjustment.  The case above revealed why x-rays are important in clinical decision making.  The decision after reading these x-rays was obvious.

X-rays and The Rest of The Story…

But what about a case where x-rays don’t tell the whole story?

Two weeks ago, a young teen was brought to my office by their parent.  This teen is an aspiring ballet dancer.  The parent stated that the teenager had performed a jump and after landing began to experience back pain.  The back pain was localized to an area near the belt line, and was moderate in intensity.  As a matter of fact, the pain wasn’t influencing much of this teens’ activity except for the one activity which created the pain: ballet.  As an aspiring ballet dancer, the ability to practice without pain was crucial.  X-rays were taken of the low back. An examination was performed and the most troubling examination finding was the loss of muscle strength in the 14 year old’s quadricep and hamstring muscles.  A week of conservative care to reduce inflammation and normalize motion in the adjacent spinal regions provided functional improvement and pain relief, but the weakness remained.  I advised the parent that a referral for an Magnetic Resonance Imaging (MRI) study was appropriate.  An MRI is an advanced diagnostic test.  The MRI reveals pathology which cannot be found with simple x-ray or any physical examination testing.  Back pain is a common complaint in the adolescent athlete.  It is estimated that close to 30% of all 11-17 year olds will experience lower back pain during their participation in sports 1. Injuries of a portion of the spine called the neural arch are a common cause of back pain in the young athlete, and can be missed in their earliest stages with x-ray alone.  Magnetic Resonance Imaging has allowed early diagnosis of these injuries, with significant positive implications for the effectiveness of care. The MRI study revealed that this dancer had suffered an acute, non-displaced fracture through the L4 pedicle ( a portion of the vertebral body neural arch near the spinal cord ) with evidence of bone marrow edema and ligament edema (swelling).  None of this would be visible with only x-rays of the spine. With this diagnosis, I referred the young patient to a pediatric orthopaedist at Steadman Hawkins Orthopaedic Group here in Greenville.
The next time you hear someone say “it’s just a stiff neck” or “it’s just lower back pain”, or hear of a therapist or chiropractor who doesn’t use x-ray, consider these cases and understand that what may seem simple may indeed be much more serious.
1 Olsen TL, Anderson RL, Dearwater SR, Kriska AM, Cauley JA, Aaron DJ, et al. The epidemiology of low back pain in an adolescent population. Am J Public Health, Apr 1992; 82(4):606-608
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