Leg twitch, particularly at night.

1. Type of Trauma: Multiple traumatic events in the farm in her early life.

2. Sign and Symptoms: Twitching of her legs during the sleep.

3. Adjustments: Lower cervical adjustment based on her 3D x-ray imaging results

4. Outcome: Reducing the frequency and the intensity of the twitching and slowly progressed to complete remission of the symptoms

   
   

The patient's medical history includes multiple traumatic events, particularly from her upbringing on a large farm, though she considered these experiences normal at the time. She has also had a history of seizures since her early 20s and has been on seizure medication ever since. Despite her medication, she continues to experience random twitching of her legs, particularly during sleep, which interrupts her rest and affects the quality of her sleep.

To explore the cause of her symptoms, a Cone Beam Computed Tomography (CBCT) scan was ordered. The following slices from the CBCT were reviewed:

The Cone Beam CT (CBCT) revealed the following findings:

• Incomplete fusion (agenesis) of the C1 posterior arch: This abnormality is a congenital variant that can contribute to mechanical disruptions in the upper cervical region.

• Forward flaring of the transverse processes (TVPs): The incomplete fusion of the posterior arch has caused the bilateral transverse processes to flare forward. This narrowing creates a constriction between the styloid processes and the transverse processes, where critical blood vessels and nerves pass.

Despite these structural findings, the patient does not present any additional neurological symptoms beyond the sleep-related leg twitching, which was the primary complaint.

The slice above, taken with a 0.9mm thickness from the midline view, reveals several important structural details:

• Hypertrophy of the anterior arch: To compensate for the incomplete posterior arch of C1, the anterior arch has enlarged, indicating an adaptive response to altered biomechanics in the upper cervical region.

• Superior migration of the odontoid process: The odontoid process has migrated superiorly, though the clivo-axial angle remains greater than 150 degrees, suggesting that the alignment in the craniocervical junction remains relatively stable despite the migration.

• Discontinuation of the posterior vertebral lines and the spinolaminar line at C5 and C6: This finding suggests some disruption in the alignment of the vertebrae at these levels.

• Flattened disc between C5/6 and posterior osteophyte growth: The intervertebral disc at the C5/6 level appears nearly flattened, indicating significant degeneration. Additionally, posterior osteophyte growth is narrowing the anterior-posterior (A-P) spinal canal, which could potentially affect the neural structures.

Axial view of the C5/6 which is visualizing the canal encroachment due to the degenerative changes.

Note the anteriorly deviated C1 in related to C2, amazingly clinically insignificant.

Rather, C5 on the right is showing a posteriorly misaligned facet joint.

The amount of the degenerative changes are so severe, determining the direction of the mild displacement/misalignment complex was difficult but I suspected it has potentially been displaced anteriorly.

The cervical adjustments were made mostly on the lower cervical spine and the outcome was very positive. The patient became asymptomatic within a couple of visits.

Disclaimer: Although the patient experienced positive outcomes in this case, individual results may vary. This case study does not guarantee that similar results will be achieved for all patients with similar symptoms. Further research is necessary to establish the effectiveness of this intervention for different conditions, and treatment plans should always be individualized based on each patient’s unique clinical presentation.