Spinal manipulation after multiple fusions in an adult with scoliosis: a case report

Abstract

Background: Spinal fusion (SF)is a common surgical intervention for individuals with idiopathic scoliosis. However, individuals may experience continued pain and disability from suspected mechanical dysfunction. Case Description: The purpose of this case report was to describe how specific thrust manipulation (TM) was used to treat a patient with scoliosis after multilevel SF. The 25-yearold female patient presented with left-sided pain in the rib, thoracic, and lumbar and sacroiliac joint regions that had been aggravated by trail running. After clearance from her surgeon, physical therapy examination and subsequent diagnosis were consistent with mechanical dysfunction of the ribs, lumbar spine, and sacroiliac joint causing decreased ability to participate in high-level activities, such as running. Outcomes: The patient was treated for eight visits her 4 months with specific TM, movement analysis, and physiotherapeutic scoliosis-specific exercises. Pain and function were assessed with the Trunk Appearance Perception scale (TAPS), Scoliosis Research Society questionnaire (SRS-22), Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), and spirometry. Pain and function improved during treatment, but outcomes for the ODI and spirometry remained the same. Discussion: The current case report suggests specific TM to areas outside of the fused spinal segments may be beneficial for decreasing pain and improving functional activities and participation levels. However, more research is needed to verify the efficacy of this treatment in clinical practice.

Manual Therapy and Exercise for the Management of Chronic Neck Pain With Multiple Neurovascular Comorbidities: A Case Report

“…Joint manipulation is shown to have wide-ranging neurophysiological effects through supraspinal, spinal, and peripheral mechanisms leading to decreased pain levels and improved muscle activation [ 15 ]. Thrust manipulation to adjacent spinal segments has been safely performed in those with single and multilevel spinal fusion [ 16 , 17 ]. Evidence regarding the safety and efficacy of joint manipulation for those with EDS is scarce; however, case reports have demonstrated the safe application of low-amplitude joint manipulation as part of a multi-modal plan of care with no reported adverse effects in individuals with EDS [ 18 ].…”