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

Abstract

Objective: The purpose of this case series is to report the effects of manipulation under anesthesia (MUA) for patients with lumbopelvic (lumbar spine, sacroiliac and/or pelvic, hip) pain in an outpatient ambulatory/hospital-based setting. Methods: A retrospective chart review of cases treated at an outpatient ambulatory surgical center in New York and a general hospital in New York was performed. Patients with preand postintervention Oswestry Low Back Pain Disability Index (ODI) scores and lumbopelvic and hip complaints were included (N = 18). No intervention other than MUA was administered between the initial and follow-up ODI scoring. Scores on the ODI were assessed within 1 week prior to MUA and again within 2 weeks postprocedure. Results: Patients underwent 2 to 4 chiropractic MUA procedures over the course of 7 to 8 days as per National Academy of Manipulation Under Anesthesia physicians' protocols. Preprocedure ODI scores ranged from 38 to 76, with an average score of 53.4. Postprocedure scores ranged from 0 to 66, with an average score of 32.8. For each patient, ODI scores were lower after MUA, with an average decrease of 20.6. Sixteen of 18 patients experienced a clinically meaningful improvement in ODI score. No adverse reactions were reported. Conclusions: For 16 of the 18 patients with chronic lumbopelvic pain reported in this study, MUA showed clinically meaningful reduction in low back pain disability.

Clinician approaches to spinal manipulation for persistent spinal pain after lumbar surgery: systematic review and meta-analysis of individual patient data

“…The mean number of patients per study was 1.5 [SD] ± 1.5. Nine studies appeared to meet the selection criteria but were excluded as IPD were not available [72,[107][108][109][110][111][112][113][114][115]]. An abbreviated form of the included studies and cases, which omits the study title, and free text descriptions of surgery and SMT, is shown in Table 1 while the full dataset is included in Additional file 2.…”

Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal

“…Advocates for the procedure frequently cite these same studies to support the use of SMUA for various diagnoses. In the more recent literature are reports of the indications for manipulation under anesthesia, including disc herniation/prolapse/protrusion/bulge, joint or spinal ankylosis, failed low back surgery, nonresponsive muscle contraction, compression syndromes with non-osteophytic entrapment, and whiplash-associated disorders [ 27 , 28 ]. Most of these indications for care have been derived from the syllabi of chiropractic post-graduate MUA certification courses and the promotional materials of MUA proponents.…”

“…Spinal ankylosis has been cited as one of the indications for SMUA [ 27 , 28 ]. However, when joints are pathologically fused, normal physiologic integrity or function cannot be expected to be restored via the stretching and/or manipulation components of the procedure.…”

Manipulations of Oblique Pulling Affect Sacroiliac Joint Displacements and Ligament Strains: A Finite Element Analysis

“…(2) Inject glucocorticoids into the SIJ via a guide wire to produce a direct anti-infammatory efect [8][9][10]. (3) Pull the subluxated SIJ back to the normal position by manipulation to reduce nerve stimulation and relieve pain [11][12][13][14]. At present, the three methods have been applied in clinical treatment, and manipulation is the most widely used [15,16].…”