This case report describes a 28-year-old female patient who experienced severe neurological symptoms after undergoing surgery to remove a thoracic astrocytoma tumor and laminectomy. She experienced constant paresthesia, numbness, and difficulty with daily activities. Application of Sacro-Occipital Technique Category I blocks immediately relieved her severe buzzing sensation in the lower extremities for up to 12 hours. The blocks are believed to have reduced tension and torsion in the spinal cord and improved cerebrospinal fluid circulation, reducing her symptoms. The patient experienced marked improvement in her symptoms, reduced need for medications, and improved quality of life with repeated application of the Category I blocks.

1. RELIEF OF NEUROLOGICAL SYMPTOMS SECONDARY
TO SURGICAL REMOVAL OF THORACIC
ASTROCYTOMA BY CATEGORY 1 BLOCK PLACEMENT:
A CASE REPORT
WILLIAM J. BORO, DC, CC, DICS

2. INTRODUCTION

3. PURPOSE OF THIS PRESENTATION
 To describe the clinical course, treatment, and positive response of a female
patient suffering from symptoms secondary to postsurgical laminectomy and
resection of a thoracic pilocytic astrocytoma.
 The application of Sacro-Occipital Technique™ Category I blocks immediately
and repeatedly relieved severe, constant paresthesia, a sense of buzzing, in
her lower extremities.
 Provide a theoretical understanding of why Category I block placement was
effective in this case.

4. WHAT IS A PILOCYTIC ASTROCYTOMA?
 AKA Juvenile pilocytic astrocytoma
 Most common CNS neoplasm of
childhood
 Cases over the age of 30 are rare
 Low grade, localized and slow-growing
 Considered benign with a favorable
prognosis
Intramedullary
Diseases of the spine and spinal
cord,
p. 225
Intradural
extramedullary
Diseases of the spine
and spinal cord, p.
209
Epidural
www.stritch.luc.edu

5. PATIENT HISTORY

6. PATIENT INFORMATION
 5’5”, 115 pound, 28 year old nulliparous female
 Two weeks of upper back pain at night
 Electric shocks down left side when moving head
 Foot jerked off the gas pedal when turning head to
change lanes
 Surgical removal of 4” long thoracic pilocytic
astrocytoma with T4-T7 laminectomy
 10% of tumor was left in situ
 Post surgery unable to walk for 2 weeks

7. PATIENT SYMPTOMS POST-LAMINECTOMY
PRIOR TO CHIROPRACTIC TREATMENT
 Constant low back pain & rib
instability
 Neuropathy
 Pain and numbness in both legs
 Pain and cramps in both feet
 Paresthesias (e.g.,Buzzing in legs)
 Difficulty with activities
 Pushing or getting in and out of
car
 Sitting at a table
 Visceral dysfunction
 Constipation with inability to
defecate without pharmaceutical
intervention
 Projectile vomiting
 No menstrual periods
 Vaginal numbness

8. COMMON POST-SURGICAL OUTCOMES
 Total recovery time from 3-12
months
 Some patients develop new
numbness or tingling pain which
sometimes is worse than the pain
before surgery
From spinalcordtumor.org
 In 2014 study of 69 patients,
neurological states
 Improved in 23.2%
 Unchanged in 68.1%
 Aggravated in 8.7%
 Functional outcomes
 Good in 75.4%
 Fair in 14.5%
 Poor in 10.1%
From Neurological Outcome after Surgical Treatment of ISCT (Lee, Cho, Kwon)

9. TREATMENT

10. CHIROPRACTIC PHYSICAL THERAPY
 Cranium
 Full spine
 Extremities and ribs
 Soft tissue release techniques
around the incision
 Visceral adjustments
 SOT Category III, II and I blocking
 Aquatherapy
 Physical Therapy

11. CATEGORY I BLOCKING RESULTS
 There was an immediate (within 5 minutes) cessation of the “buzzing” in her
legs
 Cessation of buzzing lasted up to 12 hours
 Patient took blocks home and has been able to do more activities of daily
living with less buzzing

12. DISCUSSION

13. DURAL ATTACHMENTS
 The dura attaches firmly to the cranium and the sacrum
 There are also attachments in the cervical and lumbar spine

14. ADVERSE MECHANICAL TENSION IN THE
CENTRAL NERVOUS SYSTEM
 Alf Breig states that if tension is created in the pons cord tract it can result in
symptoms of neurological deficit or excitation and hyper- or hypo-function of
various organs
 “…symptoms from a localized lesion may be relieved to a greater or lesser
extent when the pons cord tract is rendered slack.”

15. WHAT CAUSES COMPRESSION TINGLING?
 Mechanical deformation
 Oxygen lack
 Accumulation of local metabolites
 Lowering of threshold to stimulation of the
nerve by any of the above causes
 Combination of these causes
Pins & Needles, Weddell,
1946

16. WHAT DOES CATEGORY I BLOCKING ACCOMPLISH?
Category I
 Corrects rotational malposition of pelvis
 Relaxes paraspinal musculature
 Calms proprioceptors
 Affects spinal dural tension and traction on spinal nerves
 Removes dural torque
 Aligns dural ports
 Frees minor dural port constrictions

17. SO HOW DOES IT WORK?
 Tensions, torsions and deformations created by spinal and dural scar tissue
cause buzzing and increased sensitivity around the laminectomy scar
 Blocking:
 Releases cord tension and torsion
 Creates better CSF fluid circulation
 Increases removal of waste metabolites
 Improves oxygenation
 Category I blocking creates a relative flexion/extension release of the sacrum

18. CSF CHANGES AFTER BLOCKING
COURTESY OF VINCENT ESPOSITO, DC, CSCP

19. CONCLUSION

20. REDUCTION OF SYMPTOMS
 More feeling in feet
 Diminished low back pain
 Increased rib stability
 Marked improvement in balance
 No longer needing a walker
 Relief of buzzing paresthesia within
5 minutes using blocks
 Reduced need of medications
 Improved bowel function
 Menstrual periods began again

21. CONCLUSION
 It appears that there may be a subset of patients suffering from paresthesia secondary to
post surgical spinal cord tumor removal and laminectomy who will respond to the
application of Category I blocking.
 This patient’s response to care suggests a potential boon to others who suffer from this
horrible condition.
 Caution about generalizing these results to other patients is advised.
 Condition has improved, the improvement is sustained, and that when symptoms recur,
they respond quickly to this application is suggestive that this therapy is the cause of
improvement.
 It is hoped that this study will generate greater interdisciplinary interest and cooperation
so that patients suffering with this condition may have an alternate choice of treatment
with reduced need of prescription medications.