Degenerative Joint Disease

Prevalence of MRI Findings in the Cervical Spine

By Frank M. Painter|March 10, 2019|Degenerative Joint Disease, Radiology|

Prevalence of MRI Findings in the Cervical Spine in Patients with Persistent Neck Pain Based on Quantification of Narrative MRI Reports

SOURCE: Chiropractic & Manual Therapies 2019 (Mar 6); 27: 13

Rikke Krüger Jensen, Tue Secher Jensen, Søren Grøn, Erik Frafjord, Uffe Bundgaard, Anders Lynge Damsgaard, Jeppe Mølgaard Mathiasen and Per Kjaer

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark

BACKGROUND Previous studies of patients with neck pain have reported a high variability in prevalence of MRI findings of disc degeneration, disc herniation etc. This is most likely due to small and heterogenous study populations. Reasons for only including small study samples could be the high cost and time-consuming procedures of having radiologists coding the MRIs. Other methods for extracting reliable imaging data should therefore be explored.

The objectives of this study were

1) to examine inter-rater reliability among a group of chiropractic master students in extracting information
about cervical MRI-findings from radiologists´ narrative reports, and

2) to describe the prevalence of MRI findings in the cervical spine among different age groups in patients above
age 18 with neck pain.

METHOD Adult patients with neck pain (with or without arm pain) seen in a public hospital department between 2011 and 2014 who had an MRI of the cervical spine were identified in the patient registry ‘SpineData’. MRI-findings were extracted and quantified from radiologists’ narrative reports by second-year chiropractic master students based on a set of coding rules for the process.

The inter-rater reliability was quantified with Kappa statistics and the prevalence of the MRI findings were calculated.

RESULTS In total, narrative MRI reports from 611 patients were included. The patients had a mean age of 52 years (SD 13; range 19–87) and 63% were women. The inter-observer agreement in coding MRI findings ranged from substantial (κ = 0.78, CI: 0.33–1.00) to almost perfect (κ = 0.98, CI: 0.95–1.00).

The most prevalent MRI findings were foraminal stenosis (77%), uncovertebral arthrosis (74%) and disc degeneration (67%) while the least prevalent findings were nerve root compromise (2%) and Modic changes type 2 (6%). Modic type 1 was mentioned in 25% of the radiologists’ reports. The prevalence of all findings increased with age, except disc herniation which was most prevalent for patients in their forties.

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Chiropractic And Osteoarthritis

By Frank M. Painter|September 27, 2013|Chiropractic Care, Degenerative Joint Disease, Evidence-based Medicine, Osteoarthritis|

Chiropractic And Osteoarthritis

The Chiro.Org Blog

SOURCE: University of Maryland Medical Center

Although the vestiges of medical harassment against chiropractic still resonate, and are now supplanted by fringe web sites which continue to ignore the body of peer-reviewed research supporting chiropractic care, the ice is slowly melting.

Below you can read comments from the University of Maryland Medical Center website , which openly acknowledges the benefits of chiropractic care for patients suffering from the pain of osteoarthritis.

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Joint Trauma: Perspectives of a Chiropractic Family Physician

By Frank M. Painter|May 23, 2012|Chiropractic Care, Degenerative Joint Disease, Diagnosis, Evaluation & Management, Spinal Manipulation|

Joint Trauma:
Perspectives of a Chiropractic Family Physician

The Chiro.Org Blog

Clinical Monograph 8

By R. C. Schafer, DC, PhD, FICC

INTRODUCTION

The general stability of synovial joints is established by action of surrounding muscles. Excessive joint stress results in strained muscles and tendons and sprained or ruptured ligaments and capsules. When stress is chronic, degenerative changes occur.

The lining of synovial joints is slightly phagocytic, is regenerative if damaged, and secretes synovial fluid that is a nutritive lubricant having bacteriostatic and anticoagulant characteristics. This anticoagulant effect may result in poor callus formation in intra-articular fractures where the fracture line is exposed to synovial fluid. Synovial versus mechanical causes of joint pain are shown in Table 1.

Table 1. Synovial vs Mechanical Causes of Joint Pain

Feature	Synovitic Lesions	Mechanical Lesions
Onset	Symptoms fairly consistent, during use and at rest.	Symptoms arise chiefly during use
Location	Any joint may be involved.	Primarily involves weight-bearing joints.
Course	Usually fluctuates. Episodic flares are common.	Persistently worsening progression. No acute exacerbations.
Stiffness	Prolonged in the morning.	Little morning stiffness.
Anti-inflammatory effect	Aided by cold and other anti-inflammatory therapies.	Anti-inflammatory therapy of only minimum value.
Major pathologic features	Negative radiographic signs or diffuse cartilage loss, marginal bony erosions, but no osteophytes.	Radiographic signs of cartilage loss and osteophyte developments

Periarticular Lesions

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Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability

By Frank M. Painter|August 18, 2011|Degenerative Joint Disease, Spinal Manipulation|

Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability: PART I and II

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By James Brantingham, DC, CCF , Randy Snyder, DC, CCFC, and David Biedebach, DC, CCFC

Has the hypomobile manipulable joint lesion been demonstrated to exist? Historically the manipulable joint lesion has, from the beginning of the chiropractic profession, been described as a painful stiff joint. [1, 2] Joint stiffness, commonly called hypomobility (also known in the chiropractic profession as “fixation”) has become by consensus one of the most important aspects of the manipulable joint lesion in the professions of chiropractic, osteopathy, and manual medicine. [3, 4] Nearly 100 years of clinical agreement between three separate professions supports the existence of such a lesion although research now supports its existence.

Loss of full, or global, range of motion in the lumbar or cervical spines is an indirect proof that the segmental hypomobile manipulable vertebral joint lesion exists, because it is a fact that loss of full global range of motion occurs and such stiffness is considered an objective factor in chronic back pain. [5] therefore, even if this decreased range of motion is a mixture of hypermobile and hypomobile joints (i.e., a mixture of loose and stiff joints) there must be intervertebral hypomobility for global hypomobility to exist. Randomized controlled trials of manipulation documenting decreased global range of motion, and post-treatment global range of motion are growing. [6-12]

A meta-analysis of clinical trials of spinal manipulation performed by Anderson et al., clearly and strongly demonstrated that spinal manipulation is effective in restoring or increasing global, and therefore segmental lumbar mobility. Mead et al., documented post-manipulation treatment restored or increased lumbar mobility: data proving that the hypomobile manipulable joint lesion must have existed prior to treatment, and that manipulation restored to these hypomobile joints fuller mobility (Fig 1.). [6] Other studies have documented similar results. Nansel and his associates have demonstrated in three, multiply blinded, controlled studies, in which goniometer measurements confirmed cervical range of motion or global end range asymmetries or hypomobility, that after chiropractic high velocity low amplitude manipulation, statistically significant increased mobility was restored to the global and therefore segmental hypomobility areas: proof that global and therefore segmental hypomobility was returned to more normal mobility by manipulation. [14-16] (more…)

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