182. Conservative Management of Trigeminal Neuralgia and Degenerative Cervical Myelopathy: A Case Report

Article type: Case Report

Article title: Conservative Management of Trigeminal Neuralgia and Degenerative Cervical Myelopathy: A Case Report

Journal: Cureus

Year: 2023

Authors: Eric Chun-Pu Chu, Jamir Pitton Rissardo

E-mail: jamirrissardo@gmail.com

ABSTRACT

It is hypothesized that degenerative cervical myelopathy (DCM) may induce or exacerbate trigeminal neuralgia (TN) through mechanisms such as direct compression of the spinal trigeminal tract, inflammation, or vascular issues, leading to ischemia within cervical segments C3-C4, where the spinal trigeminal nucleus extends. Here, we report the potential therapeutic impact of chiropractic treatment in a 55-year-old female with TN resistance to medical therapy and DCM. The patient received targeted chiropractic care, consisting of high-velocity, low-amplitude (HVLA) spinal manipulation of the C3-C7 and T1-T4 vertebral segments to address joint dysfunction, coupled with intermittent mechanical cervical traction for 20-minute sessions, and focused radial shockwave therapy aimed at myofascial trigger points within the trapezius and levator scapulae muscles. After initiating the chiropractic care plan, the patient experienced a significant reduction in the frequency and severity of TN pain, which persisted throughout the treatment period. Notably, this alleviation in symptoms was maintained at the six-month follow-up, suggesting a sustained therapeutic effect rather than a transient improvement. The lasting nature of the pain reduction provides a compelling argument for the long-term benefits of chiropractic intervention in the management of TN, particularly in cases with concurrent DCM.

Keywords: facial pain, bell's palsy, oro-facial pain, trigeminal neuralgia, spinal manipulative therapy, chiropractor, chiropractic

Full text available at:

https://www.cureus.com/articles/223966

DOI

10.7759/cureus.55274

Citation

Chu E, Rissardo JP. Conservative Management of Trigeminal Neuralgia and Degenerative Cervical Myelopathy: A Case Report. 2024;6:e55274.

Figure 1. Illustration of the areas of facial pain. The pain was described as a sharp sensation during swallowing and lateral neck flexion, originating in the left lateral head and ear and occasionally radiating toward the right ear.

Figure 2. Radiograph of the cervical spine. A) Reduced cervical lordosis and narrowing of the C4/5 disc were identified. B) Dextro-convexity at the lower cervical and thoracic regions was observed.

Figure 3. Cervical magnetic resonance imaging, T2-weighted sagittal view. A) There is evidence of degenerative cervical myelopathy, including diffuse disc desiccation seen from C2/3 to C6/7 levels with mild loss of disc height at C5/6 level. C4/5 and C5/6 disco-osteophytic complex (white arrows) cause mild spinal canal stenosis and mild spinal cord deformation. B) C5/6 disco-osteophytic complex causes mild spinal canal stenosis and mild spinal cord deformation, more on the left (white arrow).