(J Chiropr Med 2003;2: 51-54)

Three patients with failed back surgery were treated conservatively using MUA by trained chiropractic and osteopathic physicians followed by 8 weeks of post-MUA therapy. Pain and disability outcomes all improved immediately following treatment.

Objective: Manipulation under anesthesia (MUA) is an outpatient procedure that is performed to restore normal joint kinematics and musculoskeletal function. This article presents a case of a patient with idiopathic lumbar degenerative scoliosis who developed intractable pain as an adult and reports on the outcomes following a trial of MUA. Clinical Features: A 59-year-old female patient presented to a chiropractic office with primary subjective symptoms of lower back and bilateral hip pain. Numerical pain rating scores were reported at 8 of 10 for the lower back and 9 of 10 for the sacroiliac joint/gluteal region. A disability score using a functional rating index demonstrated a score of 26 of 40 (or 64% disability). Over the preceding 5 years, the patient had tried a number of conservative therapies to relieve her pain without success. Intervention and Outcome: The patient was evaluated for MUA. The patient was scheduled for a serial MUA over 3 days. Numerical pain rating scores 8 weeks after the MUA were 1 of 10 for the lower back and 3 of 10 for the sacroiliac joint. Her disability rating decreased to 11 of 40 (28%). Radiological improvements were also observed. These outcomes were maintained at 6-month follow-up. Conclusion: Pain, functional, and radiographic outcomes demonstrated improvements immediately following treatment for this patient.

Pettibon corrective procedures seemed to be effective at reducing the thoracolumbar scoliosis 15 degrees (43%) after six weeks. The subjective and objective results of this case study warrant further such investigations.

Idiopathic scoliosis is a condition characterized by a three-dimensional curvature of the spine. However, in addition to the spinal curvature, it has also been reported that patients with idiopathic scoliosis can display other abnormal physiologic parameters, such as hormone imbalances, genetic variants, and micronutrient deficiencies. The present study evaluates the salivary progesterone levels from a historical cohort of patients seeking treatment at a single integrative medicine clinic. A group of female patients with a history of idiopathic scoliosis is compared to a group of non-scoliosis female patients. Salivary progesterone levels were 49% higher in non-scoliosis patients compared to the scoliosis group (p < 0.05). When compared by the menstrual cycling status, non-scoliosis females had a 60% higher average progesterone level, while the progesterone level among non-cycling, non-scoliosis females was 39% higher than non-cycling scoliosis females. These results suggest a potential relationship between salivary progesterone and idiopathic scoliosis among female patients.

Fluoroquinolone medications have been shown to contribute to tendinopathies, cardiotoxicity, and neurotoxicity. Low back pain is a common musculoskeletal condition for which chiropractic treatment is most often sought. This case report details a patient presenting with low back pain and a history of fluoroquinolone toxicity. The patient was initially treated with chiropractic manipulation, which increased her symptoms. She was then referred to an osteopathic physician who treated the patient with intravenous antioxidants and amino acids, an elimination diet, and probiotic supplementation. Within 4 months of therapy, the patient reported a decrease in pain, a resolution of her dizziness, shortness of breath, panic attacks, tachycardia, and blurred vision. After an additional 8 weeks of antioxidant therapy, she reported further reductions in pain and improved disability. People susceptible to fluoroquinolone toxicity may present with common musculoskeletal symptoms. A past medical history and medication history may help to identify this population of patients. People presenting with fluoroquinolone toxicity may have unidentified contributing factors that predispose them to this anomaly. This patient reported improvements in pain and disability following antioxidant amino acid therapy for a total of 6 months. The natural history of fluoroquinolone toxicity is unknown and may account for the observed improvements.

The effects of genetic variations of methylenetetrahydrofolate reductase (MTHFR) enzyme activity have been the discussion of many research papers. It has been associated with multiple neurological sequelae, and has been implicated in other chronic diseases. Although many genetic influences on the development and/or progression of idiopathic scoliosis have been reported, there has been no report of any relationship between MTHFR mutations and idiopathic scoliosis. This paper compared two groups of patients who received MTHFR genetic testing. One group had a history of idiopathic scoliosis, while the other served as a control group. The scoliosis group showed a positive MTHFR mutation in 23 out of 44 patients, while the control group showed 11/44 (P < 0.01). Given the increased incidence of MTHFR defects in scoliosis patients, this study warrants further investigation into how MTHFR variations may trigger the development or progression of idiopathic scoliosis.

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