Spinal Pain Management

Outcomes Indicators and a Risk Classification System

By Frank M. Painter|March 24, 2018|Spinal Pain Management|

Outcomes Indicators and a Risk Classification System for Spinal Manipulation Under Anesthesia: A Narrative Review and Proposal

SOURCE: Chiropractic & Manual Therapies 2018 (Mar 8); 26: 9

Dennis DiGiorgi, John L. Cerf, and Daniel S. Bowerman

Consultant Practice
Whitestone, NY, USA.

Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice.

With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia.

A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.

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Chiropractic Management of Postoperative Spine Pain

Chiropractic Management of Postoperative Spine Pain: A Report of 3 Cases

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2013 (Sep); 12 (3): 168–175

Christopher M. Coulisa, and Anthony J. Lisi

VA Connecticut Healthcare System,
West Haven, CT;
University of Bridgeport College of Chiropractic,
Bridgeport, CT.

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.

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