Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up

Objective: The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain. Clinical features: Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies. Intervention and outcomes: Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being "satisfied" with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted. Conclusion: In these 3 cases, patients with postsurgical spine pain responded positively to chiropractic care. Spinal manipulation/mobilization was tolerated without significant adverse effects.

Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Chiropractic management of postoperative spine pain: a report of 3 cases

Coulis

Lisi

2013

“…Other studies report positive outcomes in treating the PSCP patient with chiropractic spinal manipulation. [36][37][38][39][40] Coulis and Lisi 41 reported on 3 cases (1 cervical, 2 lumbar) of PSCP. They reported that 15% to 61% of spine surgery patients report persistent or recurring pain postsurgically, with 2.3% to 12% of them presenting to chiropractic offices.…”

Section: Pscp Spinal Manipulation Clinical Treatment and Benefit Outcmentioning

confidence: 99%

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series

Gudavalli

Olding²,

Joachim

et al. 2016

Purpose: The purpose of this case series is to report on changes in pain levels experienced by 69 postsurgical continued pain patients who received Cox Technic Flexion Distraction (CTFD). Methods: Fifteen doctors of chiropractic collected retrospective data from the records of the postsurgical continued pain patients seen in their clinic from February to July 2012 who were treated with CTFD, which is a type of chiropractic distraction spinal manipulation. Informed consent was obtained from all patients who met the inclusion criteria for this study. Data recorded included subjective patient pain levels at the end of the treatments provided and at 24 months following the last treatment. Results: Fifty-four (81%) of the patients showed greater than 50% reduction in pain levels at the end of the last treatment, and 13 (19%) showed less than 50% improvement of pain levels at the end of active care (mean, 49 days and 11 treatments). At 24-month follow-up, of 56 patients available, 44 (78.6%) had continued pain relief of greater than 50% and 10 (18%) reported 50% or less relief. The mean percentage of relief at the end of active care was 71.6 (SD, 23.2) and at 24 months was 70 (SD, 25). At 24 months after active care, 24 patients (43%) had not sought further care, and 32 required further treatment consisting of chiropractic manipulation for 17 (53%), physical therapy, exercise, injections, and medication for 9 (28%), and further surgery for 5 (16%). Conclusion: Greater than 50% pain relief following CTFD chiropractic distraction spinal manipulation was seen in 81% of postsurgical patients receiving a mean of 11 visits over a 49-day period of active care.

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Taber¹,

James²,

Jacon³

2014

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.