Disc Derangement

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

By Frank M. Painter|April 12, 2023|Chiropractic Management, Disc Derangement|

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

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
FROM: 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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Comparison of Treatment Outcomes in Nonspecific Low-Back Pain

By Frank M. Painter|December 1, 2018|Disc Derangement, Modic Changes|

Comparison of Treatment Outcomes in Nonspecific Low-Back Pain Patients With and Without Modic Changes Who Receive Chiropractic Treatment

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2018 (Sep); 41 (7): 561–570

Michèle Annen, MChiroMed, Cynthia Peterson, DC, MMedEd, B. Kim Humphreys, DC, PhD

Chiropractic Medicine Department,
Faculty of Medicine, University of Zurich,
Orthopaedic University Hospital Balgrist,
Zürich, Switzerland.

OBJECTIVE: The aim of this study was to determine if there was a difference in outcomes in patients with nonspecific low back pain, both with and without Modic changes (MCs), who received chiropractic care.

METHODS: This prospective outcomes study included 112 patients with low back pain without disc herniation on magnetic resonance imaging. All patients were treated with spinal manipulative therapy. At baseline, the numerical rating scale (NRS) and Bournemouth Questionnaire (BQ) for disability were collected. The NRS, BQ, and Patient’s Global Impression of Change (primary outcome) were collected at the follow-up time points of 1 week, 1 month, and 3 months to assess overall improvement. Magnetic resonance imaging scans were analyzed for the presence of MCs and, if present, classified as Modic I or II. The χ² test was used to compare the proportion of patients reporting clinically relevant “improvement” between patients with and without MCs and between Modic I and Modic II patients. The unpaired Student t test was used to compare NRS and BQ at baseline and change scores at all follow-up time points.

RESULTS: For the primary outcome measure, the proportion of patients reporting relevant “improvement” (Patient’s Global Impression of Change), and for the secondary outcome measures (NRS and BQ change scores), there were no significant differences between Modic positive and Modic negative patients or between Modic I and Modic II patients.

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Tissue Loading Created During Spinal Manipulation

By Frank M. Painter|October 24, 2017|Adverse Events, Disc Derangement|

Tissue Loading Created During Spinal Manipulation in Comparison to Loading Created by Passive Spinal Movements

The Chiro.Org Blog

SOURCE: Sci Rep. 2016 (Dec 1); 6: 38107

Martha Funabashi, Gregory N. Kawchuk, Albert H. Vette,
Peter Goldsmith, and Narasimha Prasad

Department of Physical Therapy,
University of Alberta,
Edmonton, AB, Canada

Spinal manipulative therapy (SMT) creates health benefits for some while for others, no benefit or even adverse events. Understanding these differential responses is important to optimize patient care and safety. Toward this, characterizing how loads created by SMT relate to those created by typical motions is fundamental. Using robotic testing, it is now possible to make these comparisons to determine if SMT generates unique loading scenarios. In 12 porcine cadavers, SMT and passive motions were applied to the L3/L4 segment and the resulting kinematics tracked. The L3/L4 segment was removed, mounted in a parallel robot and kinematics of SMT and passive movements replayed robotically. The resulting forces experienced by L3/L4 were collected. Overall, SMT created both significantly greater and smaller loads compared to passive motions, with SMT generating greater anterioposterior peak force (the direction of force application) compared to all passive motions. In some comparisons, SMT did not create significantly different loads in the intact specimen, but did so in specific spinal tissues. Despite methodological differences between studies, SMT forces and loading rates fell below published injury values. Future studies are warranted to understand if loading scenarios unique to SMT confer its differential therapeutic effects.

From the FULL TEXT Article:

Introduction

Spinal manipulative therapy (SMT) is a clinical intervention for low back pain which, by some estimates, is the most frequently used form of complementary and alternative medicine (CAM). [1] Similarly, SMT is also one of the most studied CAM interventions with over 250 systematic reviews and 550 randomized controlled trials since 2000.

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Chiropractic Care and Risk for Acute Lumbar Disc Herniation

By Frank M. Painter|October 23, 2017|Disc Derangement|

Chiropractic Care and Risk for Acute Lumbar Disc Herniation: A Population-based Self-controlled Case Series

The Chiro.Org Blog

SOURCE: European Spine Journal 2017 (Oct 17) [Epub]

Cesar A. Hincapie, A. Tomlinson, Pierre Cote,
Raja Rampersaud, Alejandro R. Jadad, J. David Cassidy

Injury Prevention Research Office,
Division of Neurosurgery,
Li Ka Shing Knowledge Institute
St. Michael’s Hospital
Toronto, Canada

Purpose Chiropractic care is popular for low back pain, but may increase the risk for acute lumbar disc herniation (LDH). Low back pain is a common early (prodromal) symptom of LDH and commonly precedes LDH diagnosis. Our objective was to investigate the association between chiropractic care and acute LDH with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute LDH with early surgery.

Methods Using a self-controlled case series design and population-based healthcare databases in Ontario, Canada, we investigated all adults with acute LDH requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004. The relative incidence of acute LDH with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and compared with the relative incidence of acute LDH with early surgery following PCP visits.

Results 195 cases of acute LDH with early surgery (within 8 weeks) were identified in a population of more than 100 million person-years. Strong positive associations were found between acute LDH and both chiropractic and PCP visits. The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits.

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Chiropractic Spinal Manipulation and the Risk for Disc Herniation

By Frank M. Painter|September 19, 2017|Disc Derangement, Disc Injury|

Chiropractic Spinal Manipulation and the Risk for Acute Lumbar Disc Herniation: A Belief Elicitation Study

The Chiro.Org Blog

SOURCE: European Spine Journal 2017 (Sep 18)

Cesar A. Hincapie, J. David Cassidy,
Pierre Côté, Raja Rampersaud
Alejandro R. Jadad, George A. Tomlinson

Injury Prevention Research Office, Division of Neurosurgery,
Li Ka Shing Knowledge Institute, St. Michael’s Hospital,
Toronto, Canada

Background Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians’ beliefs regarding the risk for acute LDH associated with chiropractic SMT.

Methods Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants’ elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT.

Results Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39–1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64–1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95–1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29–0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11–1.59).

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Influences of Lumbar Disc Herniation on the Kinematics

By Frank M. Painter|May 30, 2017|Disc Derangement|

Influences of Lumbar Disc Herniation on the Kinematics in Multi-segmental Spine, Pelvis, and Lower Extremities During Five Activities of Daily Living

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2017 (May 25); 18 (1): 216

Shengzheng Kuai, Wenyu Zhou, Zhenhua Liao,
Run Ji, Daiqi Guo, Rui Zhang and
Weiqiang Liu

Department of Mechanical Engineering,
Tsinghua University,
Haidian District,
Beijing, 100084, China.

BACKGROUND: Low back pain (LBP) is a common problem that can contribute to motor dysfunction. Previous studies reporting the changes in kinematic characteristics caused by LBP present conflicting results. This study aimed to apply the multisegmental spinal model to investigate the kinematic changes in patients with lumbar disc herniation (LDH) during five activities of daily living (ADLs).

METHODS: Twenty-six healthy subjects and 7 LDH patients participated in this study and performed level walking, stair climbing, trunk flexion, and ipsilateral and contralateral pickups. The angular displacement of the thorax, upper lumbar (ULx), lower lumbar (LLx), pelvis, hip, and knee was calculated using a modified full-gait-model in the AnyBody modeling system.

RESULTS: In the patient group, the ULx almost showed no sagittal angular displacement while the LLx remained part of the sagittal angular displacement during trunk flexion and the two pickups. In the two pickups, pelvic tilt and lower extremities’ flexion increased to compensate for the deficiency in lumbar motion. LDH patients exhibited significantly less pelvic rotation during stair climbing and greater pelvic rotation in other ADLs, except in contralateral pickup. In addition, LDH patients demonstrated more antiphase movement in the transverse plane between ULx and LLx, during level walking and stair climbing, between thorax and pelvis in the two pickups.

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