Denneroll Combined with Pope 2-Way Aids Patient Suffering from Chronic Whiplash Associated Disorders & Advanced S.A.D.D.
Friday, October 22, 2010 at 5:55PM 
Joseph Ferrantelli, DC
Private Practice New Port Richey, FL
CTO CBP® Seminars
CEO PostureCo.
Deed E. Harrison, DC
President CBP Seminars, Inc.
Vice President CBP Non-Profit, Inc.
Chair PCCRP Guidelines
Editor—AJCC
INTRODUCTION
In this case report we present CBP Technique management of a patient with chronic whiplash associated disorders (WAD) and associated cervical spine kyphosis, flattening of the upper thoracic kyphosis, and moderate-severe spinal arthritis and disc disease (S.A.D.D.). The patient recently had over 50 visits with another chiropractor in the state of Florida which failed to improve his condition.
Case Report
In addition to the recent 50-plus Chiropractic treatments, the patient has had ‘regular’ chiropractic care for 10 years prior to his previous doctor. Furthermore, he was suggested surgery 10 years prior due to severe disc herniations, stenosis and instability of the cervical spine.
The patient’s most recent chiropractor recommended the use of an un-named at “home wedge” type of fulcrum-traction in the cervical spine for approximately 6 months; it is unknown how often and for how long the patient performed this or if it was indicated for the type of curvature and condition. Regardless, the patient still being symptomatic, found his way to the office of one of the current authors (Dr. Joe) where new cervical spine x-rays were obtained.
- Patient Complaints
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- Patient reported that his average pain per day was an 8/10 on a numerical rating scale.
- Patient reported a limitation to his activities of daily living on a Neck Disability Index.
- Radiographic Findings
In the initial x-ray (Figure 1A), the patient has severe degenerative changes, along with significant instability upon flexion and extension radiographs. Additionally, the patient x-ray shows:
- A reversed cervical curve measuring +8.4° from C2-C7 posterior body lines,
- A straightening of the C7 posterior body line relative to vertical; indicating flattening of the upper thoracic kyphosis. See Figure 2.
Given the patient had such advanced S.A.D.D., and having no problem with treating in the office, he elected for an intensive 36 visit plan over the course of 9 weeks (35 total rehab sessions were performed).
Figure 2. C7-Body Tangent to Vertical. A line is drawn along the posterior body margin of the C7 vertebra (black line) and measured in flexion or extension relative to a vertical line originating either at the posterior inferior body of C7 or T1 (shown in Red from T1). In the Harrison Ideal Model, the ideal value of this angle = 21.5° of flexion relative to vertical.
If the value is ≤ 21.5° it indicates potential hypo-thoracic kyphosis of the upper thoracic region, T1-T4. If the value is ≥ ≤ 21.5°, then there is a potential hyper-thoracic kyphosis from T1-T4. A patient can’t have a normal cervical lordosis without a normal upper thoracic kyphosis!
- CBP Treatment Approach
In office treatment consisted of mirror image® adjusting setups to increase the upper thoracic flexion angle and increase the cervical lordosis(Figure 3). Given the mild retrolisthesis in the lower cervical spine and the flattening of the upper thoracic spine, no cervical extension exercises were given in this case as the treating clinician anticipated that this would flatten the upper thoracic kyphosis (T1-T4) even further. Additionally, Pope 2-way in office traction was performed with a lower neck front pull and an elevated back pull of approximately 45-60° above horizontal.
At home he used the Denneroll orthotic in the lower cervical-upper thoracic region (Figure 4), working up to 2 sessions per day of 20 minutes on his ‘off days’ from Dr. Joe’s clinic, and 20 minutes in the morning on the days he treated at night in the office. A total of 40 Denneroll home sessions were performed along with 35 in office CBP procedures.
Figure 3. Mirror image adjustments were given in extension and NO posterior head translation to improve the lordosis. Also, a wedge shaped block is placed in the mid-thoracic spine in order to round-increase the mid-and upper thoracic kyphosis. The thrust is given P to A in the lower cervical spine. This corrective adjustment aims to improve the cervical lordosis while simultaneously increasing the upper thoracic kyphosis.
Case Outcome
Subjectively, the patient while not totally asymptomatic, had his average pain reduced to a 2-3/10 from 8-9/10 and he was able to return to more vigorous activities of daily living with less intense painful episodes.
The follow-up lateral cervical radiographic exam found:
- That the disc spaces at C5-C7 appear to be improved in height and alignment following treatment regimen;
- The cervical kyphosis is now a cervical lordosis measuring -12.5° of extension from C2-C7 (a 21° correction);
- The C7 posterior body angle relative to vertical is moving into a more normal flexion alignment.
SUMMARY
The patient obtained quite a dramatic correction in cervical lordosis (21°) considering the extent of S.A.D.D. and the short amount of treatment duration. We believe the successful results are attributable to the addition of the Denneroll orthotic use at home in combination with the in office Pope 2-way traction and proper mirror image adjusting setups. Further, this case suggests that good patient compliance can be readily achieved with CBP protocols provided in the clinic and at home.