Biomedical subjects

Frank J Kohlbeck

Publications and source records attributed to Frank J Kohlbeck.

4 recordsLinked to original sources

PubMed2005

Supplemental care with medication-assisted manipulation versus spinal manipulation therapy alone for patients with chronic low back pain.

OBJECTIVES: To measure changes in pain and disability for chronic low-back pain patients receiving treatment with medication-assisted manipulation (MAM) and to compare these to changes in a group only receiving spinal manipulation. STUDY DESIGN: Prospective cohort study of 68 chronic low-back pain patients. METHODS: Outcomes were measured using the 1998 Version 2.0 American Association of Orthopaedic Surgeons/Council of Musculoskeletal Specialty Societies/Council of Spine Societies Outcomes Data Collection Instruments. The primary outcome variable was change in pain and disability. All patients received an initial 4- to 6-week trial of spinal manipulation therapy (SMT), after which 42 patients received supplemental intervention with MAM and the remaining 26 patients continued with SMT. RESULTS: Low back pain and disability measures favored the MAM group over the SMT-only group at 3 months (adjusted mean difference of 4.4 points on a 100-point scale, 95% confidence interval [CI] -2.2 to 11.0). This difference attenuated at 1 year (adjusted mean difference of 0.3 points, 95% CI -8.6 to 9.2). The relative odds of experiencing a 10-point improvement in pain and disability favored the MAM group at 3 months (odds ratio 4.1, 95% CI 1.3-13.6) and at 1 year (odds ratio 1.9, 95% CI 0.6-6.5). CONCLUSION: Medication-assisted manipulation appears to offer some patients increased improvement in low back pain and disability. Further investigation of these apparent benefits in a randomized clinical trial is warranted.

Adult↗

PubMed2002

Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation.

STUDY DESIGN: A retrospective review of 64 medicolegal records describing cerebrovascular ischemia after cervical spine manipulation was conducted. OBJECTIVES: To describe 64 cases of cerebrovascular accidents temporally associated with cervical spine manipulation therapy in terms of patient characteristics, potential risk factors, nature of complication, and neurologic sequelae. SUMMARY OF BACKGROUND DATA: Approximately 117 cases of postmanipulation cerebrovascular ischemia have been reported in the English language literature. Proposed risk factors include age, gender, migraine headaches, hypertension, diabetes, birth control pills, cervical spondylosis, and smoking. It is often assumed that these complications may be avoided by clinically screening patients and by premanipulation positioning of the head and neck to evaluate the patency of the vertebral arteries. METHODS: Three researchers using a uniform data abstraction instrument performed an independent review of 64 previously unpublished medicolegal records describing cerebrovascular ischemia after cervical spine manipulation. These cases were referred to a single physician for review over a 16-year period from across the United States and Canada. Descriptive statistics were calculated for characteristics of the patients and the complications. Means and standard deviations were computed for continuous variables. Frequencies and proportions were calculated for categorical variables. RESULTS: This study was unable to identify factors from the clinical history and physical examination of the patient that would assist a physician attempting to isolate the patient at risk of cerebral ischemia after cervical manipulation. CONCLUSION: Cerebrovascular accidents after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.

Adult↗

PubMed2002

Stroke, cerebral artery dissection, and cervical spine manipulation therapy.

Stroke represents an infrequent adverse reaction associated with cervical spine manipulation therapy. Attempts to identify the patient at risk and the type of manipulation most likely to result in these complications of manipulation have not been successful. A retrospective review of 64 medical legal cases of stroke temporally associated with cervical spine manipulation was performed to evaluate characteristics of the treatment rendered and the presenting complaints in patients reporting these complications. These files included records from the practitioner who administered the manipulation therapy, post stroke testing and treatment records usually by a neurologist, and depositions of the patient and the practitioner of manipulation as well as expert and treating physicians. A retrospective review of the files was carried out by three (two in 11 cases) researchers using the same data abstraction instrument to independently assess each case. These independent reviews were followed by a consensus review in which all reviewers reached agreement on file content. Ninety two percent of cases presented with a history of head and/or neck pain and 16 (25 %) cases presented with sudden onset of new and unusual headache and neck pain often associated with other neurological symptoms that may represent a dissection in progress. The strokes occurred at any point during the course of treatment. Certain patients reporting onset of symptoms immediately after first treatment while in others the dissection occurred after multiple manipulations. There was no apparent dose-response relationship to these complications. These strokes were noted following any form of standard cervical manipulation technique including rotation, extension, lateral flexion and non-force and neutral position manipulations. The results of this study suggest that stroke, particularly vertebrobasilar dissection, should be considered a random and unpredictable complication of any neck movement including cervical manipulation. They may occur at any point in the course of treatment with virtually any method of cervical manipulation. The sudden onset of acute and unusual neck and/or head pain may represent a dissection in progress and be the reason a patient seeks manipulative therapy that then serves as the final insult to the vessel leading to ischemia.

Adult↗

PubMedDate not supplied

Medication-assisted spinal manipulation.

BACKGROUND CONTEXT: The acceptance of spinal manipulation as a reasonable method of treating certain patients with spinal pain over the past decade has led to a renewed interest and increased use of these techniques performed in conjunction with commonly used medications and procedures. Manual therapy is increasingly being used in conjunction with anesthetics, sedatives or analgesics as well as local, epidural and intra-articular injections. PURPOSE: This report provides a review of the literature and presents a description of current clinical practice methods for the application of the different techniques of medication-assisted spinal manipulation therapy followed by a discussion of the current clinical support and the published indications, contraindications and complications for each of these procedures. STUDY DESIGN/SETTING: This technical report integrates a literature review with information gathered through personal interviews, review of medicine-assisted manipulation courses and observations of clinical procedures. METHODS: A PubMed search from 1966 to the present was performed to identify appropriate articles concerning the combination of spinal manipulation therapy with such medical procedures as the use of anesthetic, conscious sedation, local injection of analgesic, anti-inflammatory and proliferant agents and intra-articular injections. Additional articles and information were gathered through review of pertinent references, attendance of various technique specific seminars and communication with experts familiar with these procedures. RESULTS: Four categories of medication-assisted manipulation were identified: manipulation under general anesthesia or sedation, manipulation under epidural anesthesia with or without epidural steroid injection, manipulation under joint anesthesia/analgesia, and manipulation with injectants, such as steroids or proliferant agents. The literature consists primarily of case reports and case series with two randomized controlled trials and one cohort study. CONCLUSIONS: Medicine-assisted spinal manipulation therapies have a relatively long history of clinical use and have been reported in the literature for over 70 years. However, evidence for the effectiveness of these protocols remains largely anecdotal, based on case series mimicking many other surgical and conservative approaches for the treatment of chronic pain syndromes of musculoskeletal origin. There is, however, sufficient theoretical basis and positive results from case series to warrant further controlled trials on these techniques.

Anesthesia, Epidural↗