The Application of Mechanical Diagnosis and Therapy in Failed Anterior Cervical Discectomy and Fusion: a Case Report

The prevalence of neck pain is estimated to be 30-50 % in the general population, the second leading source of reported pain in the United States. There is limited research on the use of mechanical diagnosis and therapy (MDT) on patients with cervical pain. The effects and safety of MDT assessment and treatment for failed anterior cervical discectomy and fusion (ACDF) has yet to be established. This case report presents a 42-year-old female with a complaint of worsening neck pain with intermittent radiculopathy after an ACDF to address cervical radiculopathy. The patient received a MDT evaluation and was classified as a thoracic spine derangement. The patient was treated based on mechanical and symptomatic responses to repeated movements and mobilizations using principles of MDT. Short- and long-term outcomes were excellent, demonstrating rapid abolishment of symptoms and improvement of function in 6 visits over 4 weeks. The patient reported no pain or functional disability and had returned to all work and recreational activities. The patient demonstrated the ability to prevent and manage recurrence of symptoms independently at one-year follow-up. This case report confirms the efficacy and safety of MDT evaluation after a failed ACDF. The patient was successfully managed using MDT with full resolution of symptoms. This case report provides preliminary evidence that MDT may provide effective short- and long-term outcomes after failed ACDF. Less invasive, conservative methods, such as MDT, may be more effective at resolving cervical radiculopathy. Level of evidence 4.