Clinical Features: Patient 1 was a 27-year-old female who sustained a whiplash injury. A sharp, shooting headache developed, readily induced, and aggravated by just bending the neck backward or by turning her head. Magnetic resonance imaging revealed a disk protrusion at C4-C5 pressing the anterior cerebrospinal space. Patient 2 was a 62-year-old female who sustained a whiplash injury; her cervical movements became restricted, which precipitated headaches. Magnetic resonance imaging revealed a paramedian disk hernia between the C4 and C5 vertebrae that intruded into the right ventral cerebrospinal space.
Intervention and Outcome: After 4 weeks of manipulative therapy for patient 1, both active and passive range of motion returned to normal, and the high tumor necrosis factor-á (TNF-á) level (63 pg/mL) was substantially reduced (28 pg/mL).
Patient 2 was started on manipulative therapy twice a week for 4 weeks; after 2 months, the patient became symptom-free, and high TNF-á level (72 pg/mL) was reduced greatly (35 pg/mL).
Conclusion: Two patients with whiplash injury and disk herniation developed CHA associated with very high TNF-á levels. After manipulative therapy, these patients became symptom-free, and their TNF-á levels decreased substantially.
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