The Application of Mechanical Diagnosis and Therapy in Failed Anterior Cervical Disectomy and Fusion: a case report

Background: 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 not been reported on.

Case description: This 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 an upper thoracic spine derangement. The patient was treated based on mechanical and symptomatic responses to repeated movements and mobilizations using principles of MDT.

Outcomes: Short- and long-term outcomes were excellent, demonstrating rapid abolishment of symptoms and improvement in 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 reoccurrence of symptoms independently at one-year follow-up without seeking further healthcare.

Discussion: This case report demonstrates the efficacy and safety of MDT evaluation after an ACDF. The patient was successfully managed using MDT with full resolution of symptoms. This case report provides preliminary evidence that MDT is capable of providing effective short– and long-term outcomes after ACDF.

Level of Evidence: 4