CERVIKOGENA ANGINA. BOL U PRSIMA UZROKOVANA NEPREPOZNATOM HERNIJACIJOM DISKA U SEGMENTU C6-C7: PRIKAZ BOLESNIKA

Vjekoslav Grgić

Sažetak. U članku je prikazan slučaj 41-godišnje liječnice koja se žalila na učestale napadaje boli u prsima i otežano disa¬nje. Smetnje su počele prije šest mjeseci nakon nestručne manipulacije prsne kralježnice koju je izveo fizioterapeut dok je masirao leđa bolesnice. Brojne dijagnostičke pretrage (CT toraksa, MR torakalne kralježnice, ezofagografija, kardiološki pregled, pulmološki pregled) nisu objasnile uzrok subjektivnih simptoma. Iako se bolesnica, koja se javila u našu ordinaciju radi pregleda kralježnice i eventualne manualne terapije, nije žalila na smetnje u području vratne kralježnice, na temelju kliničkog pregleda posumnjali smo na cervikogenu anginu (CA; napadaji boli u prsima uzrokovani cervikalnom radikulopatijom; raniji izraz »cervikalna angina« terminološki je neprikladan). Naime, kliničkim pregledom našli smo jako ograničenu aktivnu i pasivnu pokretljivost vratne kralježnice, hiperalgijske kožne zone u dermatomima C6-TH4, spazam vratnih ekstenzora i gornjih dijelova m. trapeziusa, hipoesteziju u dermatomima C6-TH1 i snižen lijevi refleks tricepsa. MR pretraga vratne kralježnice pokazala je ljevostranu hernijaciju diska u segmentu C6-C7. Primjenom manualne terapije (trakcijska mobilizacija vratne kralježnice, segmentna mobilizacija, distrakcijska manipulacija u duplom Nelsonovu položaju) postignuta je potpuna regresija subjektivnih simptoma što je potvrdilo cervikalno podrijetlo boli. Analizirajući anamnestičke podatke, zaključili smo da je nestručna manipulacija prsne kralježnice (bolesnica je ležala potrbuške), koja je prouzročila jaku lokalnu bol, izazvala nagli ekstenzijsko-fleksijski refleksni pokret vratne kralježnice, koji bolesnica u tom trenutku nije uočila zbog akutne boli u području prsne kralježnice, što je rezultiralo hernijacijom već degenerativno promijenjenog diska u segmentu C6-C7 s posljedičnom CA.

Summary. This article presents the case of a 41-year-old female physician complaining about frequent chest pain attacks and breathing difficulties. Disorders started six months previously after inexpert manipulation of the thoracic spine performed by a physiotherapist while massaging the patient’s back. Numerous diagnostic examinations (CT of the thorax, MRI of the thoracic spine, esophagography, cardiological examination, pulmological examination) did not explain the cause of subjective symptoms. Although the patient, who came to our private practice setting for examination of the spine and ¬possible manual therapy, did not complain about disorders in the region of cervical spine, on the basis of clinical examination, we suspected the cervicogenic angina (CA; the attacks of chest pain caused by cervical radiculopathy; earlier term »cervical angina« is terminologically inappropriate). Namely, by means of clinical examination, we found very restricted active and passive mobility of the cervical spine, hyperalgic skin zones in the dermatomes C6-TH4, spasm of the cervical ¬extensors and upper parts of the trapezius muscle, hypoesthesia in the dermatomes C6-TH1 and decreased left triceps ¬reflex. MRI exami¬nation of the cervical spine showed left side disc herniation at the C6-C7 segment. Using manual therapy (traction mobilization of the cervical spine, segmental mobilization, distraction manipulation in full Nelson position), the complete regression of subjective symptoms was achieved which confirmed cervical origin of the pain. By analyzing ¬anamnestic data, we concluded that the inexpert manipulation of the thoracic spine (the patient was lying in prone position), which caused strong local pain, induced sudden extension-flexion reflex movement of the cervical spine which the patient did not notice at that moment because of the acute pain in the region of the thoracic spine, resulting in herniation of already degeneratively altered disc at the C6-C7 segment with consequential CA.