Neuroinflammation in the nerve roots and dorsal root ganglion decreases following 6 weeks of neural tissue management: PET/CT imaging findings in a patient with painful cervical radiculopathy.

BACKGROUND There is increasing interest in uncovering working mechanisms of physiotherapy interventions. Advanced medical imaging enables in-vivo visualisation and quantification of neuroinflammation. This case report reveals for the first time how neuroinflammation in the nervous system may change following neural tissue management.

CASE DESCRIPTION A 56-year-old man presented with a 9-month history of left C7 painful radiculopathy. He reported arm and neck pain, and numbness in the C7 dermatome. Elbow extension strength was reduced. The neurodynamic test (median nerve) was positive. MRI confirmed nerve root compression due to disc herniation C6/C7. Dynamic [11C]DPA713 PET/CT imaging revealed neuroinflammation at the neuroforamen and spinal cord. While being on the surgical waitlist, he received six weeks of neural tissue management, which included 12 sessions of nerve and joint mobilisation, and a home program of neurodynamic exercises.

OUTCOME At 6-weeks follow-up, arm and neck pain intensity had markedly reduced, which was maintained at 6 months. These improvements coincided with a substantial decrease in neuroinflammation at the affected neuroforamen (PET/CT: VT: from 12.96 to 6.21). No meaningful decrease was observed in the spinal cord (VT: from 6.43 to 5.38).

DISCUSSION Following six weeks of neural tissue management, in vivo measures of neuroinflammation reduced substantially at the affected nerve roots and dorsal root ganglion, which coincided with decreased neck and arm pain.

CONCLUSION Changes in neuroinflammation exceeding the smallest detectable difference can be measured following neural tissue management in a patient with painful cervical radiculopathy. A randomised trial to validate these findings is warranted.