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Case 1. Twitching legs at the night time.

  1. Type of Trauma: Multiple traumatic events in the farm in her early life.

  2. Sign and Symptoms: Twitching of her legs during the sleep.

  3. Adjustments: Lower cervical adjustment based on her 3D x-ray imaging results

  4. Outcome: Reducing the frequency and the intensity of the twitching and slowly progressed to complete remission of the symptoms

Early 60s female patient visited Silverdale Chiropractic for her sudden, random twitching of her legs only during the sleep. It constantly keep waking her up and affecting her sleep quality. The patient has a history of a seizure since she was in her early 20s and on the seizure medication ever since then. Yet, these twitching continues.

Patient has a history of possible multiple traumatic events, however to her the events were within norms since she was grown in a big farm.

To investigate further, Cone Beam Computed Tomography was ordered.

Followings are the slices from the CBCT.

It is showing.

  1. Incomplete fusion (agenesis) of the C1 posterior arch.

  2. Possibly due to the incomplete fusion, transverse processes (TVPs) are flaring forward bilaterally, narrowing the space between the styloid processes and the TVP where the blood vessel and the nerves are passing.

However the patient does not present any other neurological symptoms.

Above slice is 0.9mm thickness of the midline view. Notice the anterior arch has hypertrophied to compensate the posterior arch of C1 (Bone has enlarged to compensate the altered biomechanics). There is a superior migration of the odontoid process but the clivo-axial angle is more than 150 degrees.

Note the discontinuation of the posterior vertebral lines and the spinolamiar line at the level of C5 and C6. The disc between C5/6 is almost flattened to the point of fusion, posterior osteophyte growth is narrowing the A-P spinal canal.

Axial view of the C5/6 which is visualizing the canal encroachment due to the degenerative changes.

Note the anteriorly deviated C1 in related to C2, amazingly clinically insignificant.

Rather, C5 on the right is showing a posterior subluxation.

The amount of the degenerative changes are so severe, determining the direction of the subluxation was difficult but I suspected it has potentially been subluxated anteriorly.

The cervical adjustments were made mostly on the lower cervical spine and the outcome was very positive. The patient became asymptomatic within a couple of visits. Initially the duration of the asymptomatic period was about few days. She received in total of 31 visits in 2 years and 19 corrections were made during the visits. Her maximum asymptomatic duration to this date is 28 days.

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