Management of a 59-year-old female patient with adult degenerative scoliosis using manipulation under anesthesia

Abstract

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.

Chiropractic Treatments for Idiopathic Scoliosis: A Narrative Review Based on SOSORT Outcome Criteria

“…Morningstar and Strauchman used the same multimodal treatment in conjunction with manipulation under anesthesia for a 59-year-old woman with adult degenerative scoliosis. 34 The rehabilitative therapies were applied for 8 weeks after the manipulation under anesthesia. Clinical improvements in pain and disability were achieved.…”

Results of chiropractic scoliosis rehabilitation treatment at two years post-skeletal maturity in identical female twins

“…Adolescent idiopathic scoliosis occurs in approximately 2e3% of the population (Negrini et al, 2012). The conventional treatment pathway for adolescent idiopathic scoliosis involves observation for curves below 20 , bracing for curves from 20 to 40 , and surgery above 40 e45 (Negrini et al, 2011).…”

“…The conventional treatment pathway for adolescent idiopathic scoliosis involves observation for curves below 20 , bracing for curves from 20 to 40 , and surgery above 40 e45 (Negrini et al, 2011). However, these values can vary widely (Dolan and Weinstein, 2007).…”

Manipulation Under Anesthesia for Lumbopelvic Pain: A Retrospective Review of 18 Cases

“…The MUA procedure generally consists of sedation, mobilization/stretching/traction, manipulation, and post-MUA care. [15][16][17][21][22][23][24][25][26][27][28][29] Anesthesia minimizes pain, muscle spasm, and protective guarding that may occur during manipulation. Manipulation on a sedated patient is purported to enhance the practitioner's ability to break apart adhesions and repair segmental dysfunction, 11,15,17,30 leading to increased ligament, tendon, muscle, and articular flexibility.…”

“…Indications include disk herniation/prolapse/protrusion/bulge, joint or spinal ankylosis, failed low back surgery, nonresponsive muscle contraction, compression syndromes with nonosteophytic entrapment, and whiplash-associated disorders. 26 The procedure is generally reserved for patients who are responsive to noninvasive spinal manipulation techniques but who continue to experience pain and/or reduced mobility. A clinical justification for MUA has been suggested by the National Academy of Manipulation Under Anesthesia Physicians, 28 as well as the International Academy of MUA Physicians 35 and the National Association of MUA Physicians.…”