title: Ependymoma of the spinal cord presenting in a chiropractic practice: 2 case studies.
abstract: OBJECTIVE
  The purpose of this study is to discuss the cases of 2 patients with previously undiagnosed primary spinal cord tumors presenting in a private chiropractic clinical setting. An overview of treatment and outcome for an ependymoma at T12-L1 and L1-L2 is discussed.
  
  
  METHODS
  One patient was a 46-year-old Hispanic woman with 3 to 4 years of intermittent backache that usually resolved with conservative care but failed to do so during an acute episode. Lower motor neuron signs, including bowel and bladder dysfunction, were revealed upon clinical assessment. The second patient, a 38-year-old white man under routine treatment, had no lower motor neuron signs or symptoms.
  
  
  RESULTS
  Both patients were referred, one to a local hospital emergency department and the other directly to a neurosurgeon. Both underwent surgery. Upon returning home, the first patient received follow-up treatment primarily consisting of radiation therapy. Follow-up telephone interviews (3, 6, 12, 24, and 40 months) revealed the patient doing well. The second case did not require radiation therapy and was doing well at 4, 10, 12, and 18 months; the patient returned for unrelated treatment 1 year after the surgery.
  
  
  CONCLUSIONS
  These cases show that with a careful history and patient examination, enough clinical data may be gathered to make an accurate health care determination under various conditions. It also illustrates the importance of interprofessional cooperation for various disciplines of health care providers regardless of training or specialty.
authors.affiliation: Lensgraf Chiropractic Clinic, 3827 Cleghorn Avenue, Nashville, TN 32715, USA. tndc140@aol.com
authors.forename: Arthur G
authors.initials: AG
authors.lastname: Lensgraf
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Young
mesh_terms: D000328:Adult; D001416:Back Pain / Q000209:etiology* / Q000628:therapy; D002684:Chiropractic; D004806:Ependymoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007422:Intestines / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D026882:Manipulation, Chiropractic; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000209:etiology / Q000503:physiopathology; D019635:Neurosurgical Procedures; D018714:Radiotherapy, Adjuvant; D012017:Referral and Consultation; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001743:Urinary Bladder / Q000503:physiopathology