Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: A Case Report

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SOURCE:   Research Square (Apr 4, 2023)

Jessica F Billham, Erika Evans Roland, Matthew F. Gornet, Kelly Brinkman, Francine Schranck, Jim Cox, Norman W. Kettner

Logan University
Chesterfield, MO, US

The Vertebral Disc
Bioengineering 2022

INTRODUCTION:   We report utility of magnetic resonance spectroscopy (MRS) in identifying the intervertebral disc (IVD) as a pain generator, describe the contemporary pathophysiology underlying biochemical and structural components of discogenic low back pain (DLBP), and exhibit therapeutic responses to spinal manipulation.

CLINICAL FEATURES:   A 29-year old man presented with uncomplicated low back pain (LBP). The nonspecific presentation and clinical exam findings were consistent with non-specific LBP with the IVD as likely pain generator.

INTERVENTION AND OUTCOMES:   Conventional magnetic resonance imaging showed findings of IVD degeneration including Modic Type 1 changes consistent with a diagnosis of DLBP. MRS was utilized for structural and biochemical analysis of the IVDs. Altered spectral features confirmed a DLBP diagnosis. The patient underwent 12 Cox Flexion Distraction treatments at a chiropractic teaching clinic. Follow-up MRS revealed improved IVD spectral features including decreased biochemical pain markers and increased glycoprotein biosynthesis suggesting improved IVD structural integrity.

CONCLUSION:   We report the first utilization of MRS to quantify structural integrity and biochemical pain profile of the IVD in a conservatively managed DLBP patient. Findings of this case suggest spinal manipulative therapy in DLBP management may improve the structural integrity of IVDs and alter pain biochemistry.

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Low back pain (LBP) is a common health problem and cause of disability affecting upwards of 80% of adults in their lifetime. [1–3] In the USA, LBP healthcare costs have increased substantially in the past decade, making this health problem a burden on both the individual and society. [2,3] Pain is multifaceted including physiologic and psychosocial factors that should be considered in the workup of all LBP cases. [4–6]

Francio et al stated we should “aim to pursue the right treatment, for the right patient, at the right time, and directed to the correct anatomical target”. [7] Currently, 90% of LBP is classified as nonspecific (NSLBP) and lacks a clear pathoanatomical etiology, or anatomical target. Specific LBP, however, has a clear pathoanatomic source, either spinal or non-spinal in origin. [8, 9]

Often discogenic low back pain (DLBP) is initially classified as nonspecific Low back pain (NSLBP) due to vague presentations and inconclusive diagnostic test results. [10]

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