PMC9653028_01
Standing plain radiographs at initial presentation. Antero-posterior (left) and lateral neutral (right) views shows disc space narrowing (hollow black arrows), degenerative hypertrophy of facets (white arrows), and anterior marginal lipping of vertebrae that is compatible with degenerative spondylosis. Reverse cervical lordosis and mild lumbar levoconvexity are noted. Joint irregularity, subchondral erosion, and sclerosis of the left pubic symphysis (encircled in red) are likely sequelae of postpartum osteitis pubis. The central sacral line (dashed yellow line) represents the global axis, and the posterior vertebral line (yellow line) highlights the cervical curvature. The reference value for an adult is 38.1 -45.6  for lumbar L1-L5 curve by means of the Cobb method.
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Her standing radiographs (Figure 1) showed diffused degenerative spondylosis, reverse cervical lordosis, lumbar hypolordosis, and mild lumbar levoconvexity.
Surface electromyography (sEMG) comparison of pre- and post-intervention. (A) At initial presentation, high readings reflect spasm in the bilateral trapezius and sacrospinalis (erector spinae) muscle groups. (B) The normalized sEMG signal of the muscle groups and the dropped electrophysiological (EP) stress score positively correspond to patient's symptom relief after the 16-month chiropractic therapy. The EP stress score is the sum of all muscle activity on the spine measured in microvolts.
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In a schematic representation, the myoelectric activity of each measured level is recorded and expressed by color bars. sEMG revealed high levels of muscle tension in our patient's cervical and all spinal segments (Figure 2). The patient's straight neck had been corrected and paraspinal sEMG activity at most spinal levels had returned to baseline myoelectric activities (Figure 2B).
Comparison of cervical alignment over time in the same patient shown in Figure 1. (A) At the 16th month evaluation, the sagittal Cobb C2-C7 is 3 . The posterior vertebral line (yellow line) highlights the cervical curvature. (B) Repeat radiographs radiograph at the 26th month evaluation demonstrates a regain of cervical lordosis to Cobb 14 . The exostoses in the spinous process C2/C3 interspace and sesamoid ossicles (white arrow) of the nuchal ligament indicate a mechanical stress of the nuchal osteo-ligamentous attachment.
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A final follow-up visit at 26 months revealed that the corrected effects were maintained (Figure 3) and no treatment-related adverse events were observed.
Clinical timeline of the presenting case.
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A summary timeline of events for this case is presented in Figure 4.