title: Intermittent cervical traction and thoracic manipulation for management of mild cervical compressive myelopathy attributed to cervical herniated disc: a case series.
abstract: METHODS
  Case series.
  
  
  OBJECTIVE
  To describe the management of 7 patients with grade 1 cervical compressive myelopathy attributed to herniated disc using intermittent cervical traction and manipulation of the thoracic spine.
  
  
  BACKGROUND
  Intermittent cervical traction has been indicated for the treatment of patients with herniated disc and has been suggested to be helpful for patients with cervical compressive myelopathy. Manipulation of the thoracic spine has been utilized to safely improve active range of motion and decrease pain in patients with neck pain.
  
  
  METHODS
  Seven women with neck pain, 35 to 45 years of age, were identified as having signs and symptoms consistent with grade 1 cervical compressive myelopathy. Symptom duration ranged from less than 1 week to 52 weeks. All patients were treated with intermittent cervical traction and thoracic manipulation for a median of 9 sessions (range, 2-12 sessions) over a median of 56 days (range, 14-146 days). Numeric Pain Rating Scale and Functional Rating Index scores served as the primary outcome measures.
  
  
  RESULTS
  The median decrease in pain scores was 5 (range, 2-8) from a baseline of 6 (range, 4-8), and median improvement in Functional Rating Index scores was 26% (range, 10%-50%) from a baseline of 44% (range, 35%-71%). Dizziness was eliminated in 3 out of 4 patients and chronic headache symptoms were improved in 3 out of 3 patients. There were no adverse events or outcomes.
  
  
  CONCLUSIONS
  Intermittent cervical traction and manipulation of the thoracic spine seem useful for the reduction of pain scores and level of disability in patients with mild cervical compressive myelopathy attributed to herniated disc. A thorough neurological screening exam is recommended prior to mechanical treatment of the cervical spine.
authors.affiliation: Wilford Hall Medical Center, Lackland AFB, San Antonio, TX, USA. atexanpt@earthlink.net
authors.forename: David A
authors.initials: DA
authors.lastname: Browder
authors.forename: Richard E
authors.initials: RE
authors.lastname: Erhard
authors.forename: Sara R
authors.initials: SR
authors.lastname: Piva
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000473:pathology*; D004185:Disability Evaluation; D004244:Dizziness / Q000628:therapy; D005260:Female; D006261:Headache / Q000628:therapy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications*; D020393:Manipulation, Spinal; D008875:Middle Aged; D018908:Muscle Weakness / Q000628:therapy; D010147:Pain Measurement; D010808:Physical Examination; D016059:Range of Motion, Articular / Q000502:physiology; D013117:Spinal Cord Compression / Q000145:classification / Q000209:etiology / Q000628:therapy*; D013904:Thoracic Vertebrae; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome