The AAO Journal, 2022/06, 32(2):21. doi: 10.53702/2375-5717-32.2.15, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (https://meridian.allenpress.com/aaoj/article/32/2/15/482674/LBORC-NUFA-Poster-Abstracts-2022-Students)

Keywords:

case report [736]
Chiari I malformation [1]
leg length inequality [15]
OMT [3924]
osteopathic manipulative treatment [3945]
scoliosis [32]
diagnosis [412]

Abstract:

Introduction/Background: Chiari I Malformation is a congenital condition characterized by abnormally-shaped cerebellar tonsils that are downwardly displaced below the level of the foramen magnum. While the pathogenesis behind Chiari Malformation has not been elucidated, one proposed explanation involves an abnormal fixation of the spinal cord, known as Tethered Cord Syndrome. Additional findings associated with a tethered cord include scoliosis, leg length inequality, and leg pain. Case: A 4-year-old male patient with Chiari I Malformation presented to the clinic with a 2-year history of intermittent nocturnal 10/10 bilateral posterior leg pain. The patient was noted to have a 7 mm short left leg and a scoliotic curve convex left in the lumbar region and convex right in the thoracic. A 3 mm heel lift was initiated during the original visit. Osteopathic Manipulative Treatment (OMT) was used to treat somatic dysfunctions found in the thoracic region, lower extremities, and sacrum. Treatment modalities included soft tissue, muscle energy, and articulation. Results: Over the course of 3 follow up appointments, the patient had significant improvement in their leg pain, rating it a 3/10, and experienced fewer and shorter painful episodes. Additionally, there was steady improvement in the patient’s scoliotic curve along with leveling of the sacral base. Discussion: Our case study suggests that OMT and heel lift therapy can be effective in treating leg pain and scoliosis in the setting of Chiari Malformation in a pediatric patient. Clinical Relevance: Addressing the leg length inequality and leveling the sacral base may have alleviated tension of a tethered cord, thus improving the scoliosis and posterior leg pain. A limitation is that follow-up scoliotic measurements haven’t been performed yet as treatment is still ongoing.