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Results for “Manipulation, Spinal”

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PubMedDate not supplied

Innervation of the human costovertebral joint: implications for clinical back pain syndromes.

BACKGROUND: The diagnosis of pain in the upper back, shoulder, chest, and arm is often made with considerable confusion and may be accompanied by needless expense and suffering by the patient. Despite the paucity of evidence concerning the tissues and mechanisms responsible for interscapular and atypical chest pain or "pseudo-angina," practitioners of manual therapy maintain that manipulation of the costovertebral elements and associated soft tissues may be helpful in the treatment of these painful conditions. OBJECTIVE: We have examined the costovertebral complex in humans with respect to the presence of immune-like reactivity to neurofilament protein and the neuropeptide substance P and calcitonin gene-related peptide, markers that reveal the presence of axons in peripheral tissues. DESIGN: Human costovertebral complexes obtained at autopsy were processed with standard histologic examination and immunocytochemical methods to detect the presence of neurofilaments, substance P, and calcitonin gene-related peptide. MAIN OUTCOME MEASURES: Outcomes were descriptive and did not require statistical methods. RESULTS: All costovertebral joints contained innervation within the anterior capsule and synovial tissues. In 4 separate cases, the costovertebral joints contained large intraarticular synovial inclusions or "meniscoids" found to contain small bundles of axons with immune-like reactivity to substance P. Axon bundles were identified in serial section with monoclonal antibodies to neurofilaments as well as with urea-silver nitrate staining. CONCLUSIONS: The costovertebral joint has been considered a candidate for producing back pain and/or pseudo-angina that may be ameliorated by spinal manipulation. This study has demonstrated that the costovertebral joint has the requisite innervation for pain production in a similar manner to other joints of the spinal column.

Back Pain↗

PubMed1997

Movements of vertebrae during manipulative thrusts to unembalmed human cadavers.

OBJECTIVE: The purpose of this study was to measure the relative movements of vertebrae during manipulative thrusts to unembalmed post-rigor mortis human cadavers. SETTING: The investigation was conducted in the gross anatomy laboratory at the University of Calgary. SUBJECTS: Two 77-yr-old, unembalmed, post-rigor mortis, male cadavers were used. INTERVENTIONS: The movements of vertebrae were investigated by using high-speed cinematography to record the movements of bone pins threaded into T10, T11 and T12 during spinal manipulative therapy to unembalmed post-rigor human cadavers. A single clinician delivered a series of posterior-to-anterior (p-to-a) thrusts to the right transverse process of either T10, T11 or T12, using a reinforced hypothenar contact. Relative p-to-a and lateral translations, as well as axial and sagittal rotations, in T10-T11 and T11-T12 were calculated. Corresponding p-to-a forces exerted by the clinician onto the cadaver were recorded using a pressure pad. MAIN RESULTS: Significant relative movements were measured primarily between the targeted and immediately adjacent vertebrae during the thrusts. Vertebral pairs remained slightly 'hyper-extended' after the rapid thrusts to T11, when the p-to-a forces returned to preload levels. CONCLUSIONS: These findings may be useful for the understanding of the deformation behavior of the vertebral column during therapeutic manipulation. A fully three-dimensional analysis of all six degrees of freedom, using a larger number of unembalmed cadavers, would be useful in clarifying the relationship between the externally applied forces and the observed relative movement patterns of the vertebrae.

Aged↗

PubMed1987

Posterior cervical fusion with local anesthesia. The awake patient as the ultimate spinal cord monitor.

A technique is described for posterior cervical stabilization with wire and fusion using iliac crest bone graft, performed under local anesthesia. Thirty-four consecutive cases performed at Rancho Los Amigos Medical Center are reviewed. In patients with unstable cervical spines and variable degrees of neurologic injury, posterior stabilization and fusion using local anesthesia allows the patient to interact with the surgeon during crucial moments of spinal manipulation. The technique is well tolerated by patients, and no untoward complications have occurred with use of this technique.

Adolescent↗

PubMed1994

Spinal cord potential recordings from the extradural space during scoliosis surgery.

For monitoring spinal cord functions during corrective surgery of scoliosis, we have recorded percutaneously from the posterior extradural space at the C5-7 levels the ascending conducted spinal cord potentials (ASCP) in response to extradural stimulation of the cauda equina in 134 patients. The ASCP consists of three spike-like components (C1, C2 and C3) followed by slow components. The extradurally recorded ASCP were not affected by anaesthetic agents. There were no significant differential effects of spinal distractions on each of the three spike potentials. There were no post-operative neurological abnormalities in patients whose ASCP showed no changes, amplitude increases, amplitude decreases of less than 50% or latency increases (> 0.2 ms) during spinal manipulations (no false negatives, but some false positives). Five patients who suffered postoperative neurological damage exhibited more than 50% changes in amplitude of the ASCP during surgery. All these neurological sequelae occurred in the first 80 patients. In the last 54 patients, in whom the distraction forces on the spine were controlled rapidly by observation of the amplitude changes in ASCP, there were no postoperative neurological abnormalities, except for one patient in whom an accidental spinal cord injury was produced by a hook. The results suggest that the distraction force on the spine must be reduced immediately when the amplitudes of the ASCP decrease by more than 50% of control values with or without latency increases.

Adolescent↗

PubMed1995

Cervical radiculopathy: a case for ancillary therapies?

OBJECTIVE: To present two cases, one of a patient with a radicular syndrome and another of a patient with a pseudoradicular syndrome. CLINICAL FEATURES: A 45-yr-old man visited one chiropractic clinic complaining of a "pinched nerve" in his neck, with pain and paresthesia in his left hand. He reported that these symptoms began after a work accident 1 month before, when he lifted a heavy object. Radiographs revealed disk space thinning at C4-5, C5-6 and C6-7. CT scans revealed foraminal narrowing with a minor disk bulging at the level of C5-6 and a large disk protrusion at C7-T1. The second patient is a 60-yr-old man with left shoulder and cervical spine pain. The patient stated that the shoulder pain felt like an ache and had begun 2 wk earlier when he had awakened with pain in the shoulder and a stiff neck. X-ray evaluation revealed a moderate level of degenerative change at the the C4-5, C5-6 and C7-T1 region. CONCLUSION: This article identifies the similarities and variations between two syndromes receiving chiropractic intervention that included ancillary therapy. Certain conditions, including cervical radiculopathy, seem to respond well to chiropractic spinal manipulative therapy. However, in other conditions with similar symptomatology, appropriate referral may be necessary for the condition to respond. Alternatively, adjunctive or ancillary therapy may be indicated to improve the effect of the chiropractic intervention.

Cervical Vertebrae↗

PubMed2005

Experience and practice organization in learning a simulated high-velocity low-amplitude task.

OBJECTIVE: To evaluate the effect of practice schedule, type of feedback, and experience level on simulated force production accuracy in chiropractic students. METHODS: Thirty-three chiropractic students simulated a high-velocity low-amplitude prone thoracic spine manipulation. Three force goals based on percent of maximum thrusting ability were used in blocked and random variable practice. Participants received either visual feedback or knowledge of performance feedback regarding their force-time history. Serial retention tests without feedback followed blocked and random variable practice. Peak and average rates of thrust development, as well as the constant error, absolute constant error, and variable error of peak force production, were calculated. CONCLUSION: Familiarity and practice of high-velocity low-amplitude spinal manipulation resulted in greater accuracy of peak force production. Lower error scores were observed in acquisition with blocked variable practice. However, short-term accuracy was enhanced in retention when participants had used random variable practice. Random variable practice combined with visual feedback improved force production accuracy in retention. The variability of peak force production increased to 61% of maximum thrusting ability and then decreased. The greatest accuracy with least variability of peak force production was seen near 75% of maximum thrusting ability.

Adult↗

PubMedDate not supplied

Characteristics of chiropractic practitioners, patients, and encounters in Massachusetts and Arizona.

OBJECTIVE: To describe chiropractic care using data collected at the time of each patient visit. METHODS: Random samples of chiropractors licensed in Arizona and Massachusetts were recruited to participate in interviews about their training, demographics, and practice characteristics. Interviewees were then recruited to record information about patient condition, evaluation, care, and visit disposition on 20 consecutive patient visits. RESULTS: Data for 2550 chiropractic patient visits were recorded. Care for low back, head and neck pain accounted for almost three quarters of visits. Extremity conditions and wellness care accounted for approximately half of the remaining visits. Spinal and soft tissue examinations were the most frequently reported diagnostic procedures (80% and 56% of visits, respectively), and high-velocity spinal manipulation techniques were the most frequently reported therapeutic procedures (almost 85% of visits). Rehabilitation exercises, thermal modalities, electric stimulation, and counseling/education/self-care were each performed during approximately 25% of visits. Approximately 85% of patients seen were self-referred, whereas only approximately 5% came from medical physicians. Approximately 35% of visits had an expected source of payment directly from the patient. Approximately 80% of visits ended with a plan for the patient to return at a specified time. CONCLUSION: These findings are consistent with the findings of previous studies and confirm that chiropractors use conventional patient assessment approaches with specific attention to spinal and musculoskeletal procedures, infrequently incorporating interventions commonly associated with other complimentary and alternative care providers. These findings illustrate that diagnostic assessment and follow-up are integral to chiropractic clinical encounters and offer a baseline for best practices development. The data also offer insight into chiropractic use and may be of interest to chiropractic leaders and education planners for professional development purposes.

Adult↗

PubMed2005

Superior mesenteric artery syndrome in children and adolescents with spine deformities undergoing corrective surgery.

OBJECTIVE: Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA) is associated with spinal manipulation in the surgical or conservative management of scoliosis. The purpose of the present study was to investigate the prevalence of SMA syndrome in a cohort of 165 consecutive pediatric patients who underwent spine deformity surgery and had minimum 2-year follow-up. METHODS: The study group comprised 85 patients with idiopathic scoliosis, 20 patients with neuromuscular and 18 patients with miscellaneous or syndromic scoliosis, and 42 patients with congenital spine deformities. Posterior spine arthrodesis was performed in 94 patients, combined anteroposterior in 60 patients, and anterior spinal fusion in 11 patients. RESULTS: We identified four patients who developed SMA syndrome postoperatively. These were all markedly underweight adolescent girls; two patients had adolescent idiopathic scoliosis, one had neuromuscular scoliosis, and one congenital scoliosis. Third-generation instrumentation systems with derotational effect were used in three patients. The spine arthrodesis in the patient with neuromuscular scoliosis was performed using bone graft followed by application of a spinal jacket. The symptoms developed at a mean of 3.7 days post surgery and included nausea, vomiting, increased nasogastric aspirates, and abdominal pain and distension. Conservative management with prolonged nasojejunal feedings achieved resolution of the symptoms in all but one patient, who required derotation of the duodenum and jejunum. There was no evidence of recurrence of the condition in any patient. The prevalence of SMA syndrome in our series was 2.4%. CONCLUSIONS: This work draws attention to the significance of the prevention of the condition by recognizing patients who are at a higher risk. An early diagnosis of SMA syndrome will allow for application of conservative methods and will increase the chances for a successful outcome.

Adolescent↗

PubMed2003

Patient satisfaction, characteristics, radiology, and complications associated with attending a specialized government-funded multidisciplinary spinal pain unit.

OBJECTIVE: To prospectively document the satisfaction of a random sample of patients attending a specialized multidisciplinary spinal pain unit in the Australian public health care system and to collect associated data on patient characteristics, radiological findings, treatment modalities used, and any significant complications. Design and setting Spinal pain syndrome patients attended the specialized Multidisciplinary Spinal Pain Unit at Townsville General Hospital and the Kirwan Community Health Centre (Queensland, Australia) for diagnosis and management (ie, chiropractic spinal manipulation, medication, or needle acupuncture). A patient satisfaction questionnaire was sent to a random sample of patients in this Queensland Government funded service that was approved by the health authority's Ethics Committee. RESULTS: A total of 1775 new patients (949 men, 826 women; aged 10 to 91 years; average age = 43 years) visited the unit. Medical referral accounted for 40% of patients, chiropractic for 2%, osteopathy for 1%, and other referrals for 0.7%; 40.3% were self-referred and 16% were specifically referred for a medicolegal consultation and examination following work-related or motor vehicle accident injuries. Thirty-nine patients (2.2%) were found to have acute pain (< 28 days). Of 941 patients who could accurately recall when symptoms first began, 69 (7.3%) presented with subacute pain (4 to 12 weeks duration), and 872 (92.7%) presented with chronic spinal pain syndrome (>12 weeks duration). Following extensive investigations, 1474 patients (83%) had radiologically identifiable abnormalities, including osseous or soft tissue anomalies. There was only 1 significant complication (pneumothorax) out of 7831 acupuncture treatment sessions, representing 0.01% of patients and 0.006% of a total of 16,936 examinations and treatments administered at the unit. The patient satisfaction questionnaire resulted in an extremely high satisfaction score. CONCLUSION: A public hospital or community health center based specialized spinal pain syndrome unit is useful for referring clinicians who wish to obtain a further opinion for challenging spinal pain syndrome patients in the lower socioeconomic group that cannot afford private health care.

Adolescent↗

PubMed1996

[Manipulations of cervical vertebrae and trauma of the vertebral artery. Report of two cases].

Vertebrobasilar-distribution stroke is a rare but sometimes severe complication of chiropractic neck manipulation. We report two patients with dissections of the vertebral arteries authenticated two and six days after the cervical manipulation. In the first case, a Wallenberg's syndrome occurred due to a dissection of the right intracranial vertebral artery; the patient was treated with anticoagulant therapy but little improvement of the disorder was noted. The second patient had transitory neurologic manifestations which led to the discovery of an intimal tear of the ostium of the right vertebral artery with a floating clot. Further embolic complications were avoided by performing a venous bypass between the right common carotid and the vertebral artery at the base of the skull. Therapists should be aware of vertebrobasilar complications after spinal manipulations and should ask for early explorations (brain CT, cerebral angiography) to institute rapidly the most appropriate treatment.

Aortic Dissection↗

PubMed2006

Cord and cauda equina injury complicating elective orthopedic surgery.

STUDY DESIGN: Presented is a case series of 3 patients, all of whom developed neurologic deficits due to cord or cauda equina compression during elective extremity surgery. OBJECTIVES: To identify characteristics of presentation that may differentiate cord or cauda equina injury from peripheral nerve palsy following extremity surgery and to establish the value of early decompression in patients with intraoperative injury. SUMMARY OF BACKGROUND DATA: Intraoperative neural injury has been described in association with epidural and spinal anesthesia, with cervical or spinal manipulation in the face of instability, and with ischemic injury suffered during extensive vascular repair. However, it has not been described after uncomplicated elective extremity surgery. METHODS: Retrospective review of a case series. RESULTS: In 1 patient, intraoperative paraplegia occurred after routine shoulder arthroscopy. A second patient underwent elective bilateral total hip replacement and awoke with neurologic deficits in both lower extremities, then went on to develop an acute cauda equina syndrome. The third patient developed a central cord syndrome following an otherwise uncomplicated total hip replacement. Two patients were initially misdiagnosed as peripheral nerve palsies. All 3 patients had preexisting spinal stenosis at the level of neural injury. All underwent routine positioning and anesthetic care but were recognized as having a neural injury early in the recovery period. In only 1 case was the diagnosis of a cord level injury made immediately. All 3 patients were treated with urgent surgical decompression once diagnosed. Following surgery, neurologic symptoms improved in each of the 3 patients allowing early mobilization. CONCLUSIONS: Spontaneous neural injury is rare but can occur to the anesthetized patient. Neurologic examination should be routinely performed in the recovery room; and if significant neurologic deficits are seen, investigative workup should not be delayed. If an intraspinal lesion is identified, immediate decompression may offer favorable results. Neurologic deficits should not be dismissed as peripheral palsies without careful evaluation.

Adult↗

PubMed1994

Lymphocyte profiles in patients with chronic low back pain enrolled in a clinical trial.

OBJECTIVE: Our earlier findings suggest that patients with musculoskeletal complaints have lower numbers and percentages of natural killer (NK) cells than asymptomatic subjects. This study examines patient lymphocyte profiles, as a secondary outcome measure, in a trial of manipulative therapies to treat chronic low back pain (LBP) of mechanical origin. DESIGN: The patients were compared in a randomized controlled trial. Baseline measures were collected at the initial visit; all patients were scheduled for 11 treatments in 14 days. Treatment consisted of either a high-force, high-velocity, low-amplitude manipulation procedure; a low-force, high-velocity, low-amplitude procedure or a series of educational lectures on lower back pain. Posttreatment measures were collected at the final treatment session; follow-up measures were obtained 2 wk later. SETTING: The study was conducted at a chiropractic teaching clinic in the suburban Chicago area. PARTICIPANTS: Individuals over 18 were eligible if they were new patients or repeat patients with a 6 month's hiatus, if the chief complaint was LBP of greater than 50 days' duration, if pain was elicited with palpation over one or more of the facet joints from the spinal levels between L1 and S1 and including the sacroiliac joints, and if there was absence of pain referral or if pain referral was only scleratogenous in nature. Criteria for excluding patients included hard neurologic signs, systemic disease potentially affecting the musculoskeletal system, contraindication to spinal manipulation such as osteoporosis, fracture or other bony pathology, or treatment with medication intended to relieve symptoms associated with their LBP. Eligibility was determined by a staff diagnostic team independent of the attending physician. Three hundred sixty-seven of 1,275 consecutive new patients met the eligibility criteria. Of these, 209 participated. These results are for 201 patients from whom flow cytometric data were obtained. OUTCOME MEASURES: Both absolute numbers and percentages of B-lymphocytes, T-lymphocytes, T-Helper (TH), T-Suppressor (TS) and NK lymphocytes were determined. Blood samples were collected at the same time that the primary outcome measures were obtained. Cells were stained with two-color monoclonal antibodies directed against specific cell surface antigens, and each lymphocyte subpopulation was quantified directly from lysed whole blood with a Coulter Epics Profile II flow cytometer. RESULTS: Thirty-five patients dropped out before the follow-up visit and technical problems resulted in the loss of data from 17 more and the exclusion of some subpopulation data. In all, 148 cases were analyzed for B cells, 146 for TH, TS and NK cells and 138 for cells that carried both the NK and TS marker. A one-way analysis of variance revealed no significant differences in the lymphocyte profiles at baseline among the three groups. All subpopulation baseline values were within reported reference ranges for normal adult populations. However, the percentage of NK cells (9.1%) was below the published minimum critical value. A repeated measures analysis of variance was used to determine whether treatment effects changed over time, that is, treatment-time interaction. The cell types for which the interaction tests were at or near statistical significance were: TH cells (p = .0208), total T cell percent (p = .0928) and absolute total T cells (p = .0908). Interaction tests for differences in either percent or absolute counts of B cells, TS cells, or NK cells were not statistically significant. CONCLUSIONS: This is the first report of lymphocyte profiles in patients with diagnosed chronic LBP. Our finding of a lower percentage of NK cells in these patients confirms our earlier finding that patients with musculoskeletal problems have a lower percentage of NK cells than do asymptomatic subjects. However, manipulative therapy was not shown to have a clinically significant effect on either the absolute n

Adult↗

PubMedDate not supplied

Basic science research related to chiropractic spinal adjusting: the state of the art and recommendations revisited.

OBJECTIVE: The objectives of this white paper are to review and summarize the basic science literature relevant to spinal fixation (subluxation) and spinal adjusting procedures and to make specific recommendations for future research. METHODS: PubMed, CINAHL, ICL, OSTMED, and MANTIS databases were searched by a multidisciplinary team for reports of basic science research (since 1995) related to spinal fixation (subluxation) and spinal adjusting (spinal manipulation). In addition, hand searches of the reference sections of studies judged to be important by the authors were also obtained. Each author used key words they determined to be most important to their field in designing their individual search strategy. Both animal and human studies were included in the literature searches, summaries, and recommendations for future research produced in this project. DISCUSSION: The following topic areas were identified: anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system. A relevant summary of each topic area and specific recommendations for future research in each area were the primary objectives of this project. CONCLUSIONS: The summaries of the literature for the 6 topic sections (anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system) indicated that a significant body of basic science research evaluating chiropractic spinal adjusting has been completed and published since the 1997 basic science white paper. Much more basic science research in these fields needs to be accomplished, and the recommendations at the end of each topic section should help researchers, funding agencies, and other decision makers develop specific research priorities.

Animals↗

PubMedDate not supplied

The effect of chiropractic manipulation on salivary cortisol levels.

BACKGROUND: The stress response in humans is a healthy response and is necessary for life. The effects of chiropractic manipulation (CM), if any, on stress are ill-defined. Cortisol has been used as an accurate measure of the stress response system in humans. Salivary cortisol is a noninvasive technique to accurately quantify biologically active cortisol. OBJECTIVE: To determine whether basal salivary cortisol levels can be properly detected and whether CM has any direct effect on basal salivary cortisol levels in humans. METHODS: Subjects were adult male students attending a chiropractic college. Salivary samples were collected for 5 weeks. During Week 1, samples were collected by the students at home upon waking. During Weeks 2 through 5, home samples were collected upon waking and were followed by an additional time course of samples collected in a laboratory setting before and after CM. Salivary cortisol was measured by enzyme-linked immunoassay. RESULTS: Chiropractic manipulative therapy did not significantly change basal salivary cortisol levels. The time course of acute changes to cortisol levels was independent of testing week and group. A decrease in salivary cortisol was detected over time on each trial testing day. Overall, cortisol levels significantly decreased from the time of the home samples until the pretreatment laboratory measurement (P <.05). Cortisol levels subsequently decreased from pretreatment to 15 minutes after treatment (P <.05). After treatment, there were progressive decreases in cortisol levels from the 15- and 30-minute time points to the 60-minute time point (P <.05). CONCLUSION: The results of this pilot study suggest that there is no effect of CM on salivary cortisol levels in asymptomatic subjects. As such, we conclude that neither the anticipation of CM nor the spinal manipulative procedure itself induces a state of stress or anxiety.

Adult↗

PubMed1983

An evaluation of the effect of chiropractic manipulative therapy on hypolordosis of the cervical spine.

Cervical curve depth (CCD) was radiographically evaluated in 35 patients who presented with cervical hypolordosis or kyphosis (CH/K). Of these, one group of 20 patients received chiropractic manipulative therapy (CMT) for the purpose of correcting the disorder. A second group of nine patients received both CMT and an orthopedic cervical pillow for in home correction of the CH/K. A control group of six patients received CMT which was not intended to correct the CH/K. The purpose of the study was to determine the efficacy of CMT in the correction of CH/K. Analysis of the data indicated that CMT is significantly effective in the treatment of CH/K. There was a mean improvement of 4.55 degrees (p less than 0.01) in the group receiving only CMT, as assessed by CCD radiographic analysis. There was also significant improvement of 2.22 degrees (p less than 0.05) in the group receiving both CMT and orthopedic cervical pillow therapy. The findings lend support to fundamental chiropractic tenets such as that spinal manipulation is beneficial in correcting biomechanical disorders of the spine. Specifically, the study documents the role of chiropractic care in the correction of CH/K as may result from postural, musculoligamentous, or traumatic etiology such as the so-called "whiplash" injury.

Cervical Vertebrae↗

PubMed1995

Improved amplitude of myogenic motor evoked responses after paired transcranial electrical stimulation during sufentanil/nitrous oxide anesthesia.

BACKGROUND: Measurement of motor evoked responses to transcranial stimulation (tc-MER) is a technique for intraoperative monitoring of motor pathways in the brain and spinal cord. However, clinical application of tc-MER monitoring is hampered because most anesthetic techniques severely depress the amplitude of motor evoked responses. Because paired electrical stimuli increase tc-MER responses in awake subjects, we examined their effects in anesthetized patients undergoing surgery. METHODS. Eleven patients whose neurologic condition was normal and who were undergoing spinal or aortic surgery were anesthetized with sufentanil-N20-ketamine. Partial neuromuscular blockade (single-twitch height 25% of baseline) was maintained with vecuronium. Single and paired electrical stimuli were delivered to the scalp, and compound action potentials were recorded from the tibialis anterior muscle. The amplitude and latency of the tc-MERs were measured as the interval between paired stimuli was varied between 0 (single stimulus) and 10 ms. All recordings were completed before spinal manipulation or aortic clamping. RESULTS: Median amplitude of the tc-MER after a single stimulus was 106 microV (10th-90th percentiles: 23-1,042 microV), and the latency to onset was 33.2 +/- 1.4 ms (SD). With paired stimuli (interstimulus interval 2-3 ms), tc-MER amplitudes increased to 285 (79-1,605) microV, or 269% of the single-pulse response (P < 0.01). Reproducibility of individual responses increased with paired stimulation. Onset latency decreased to 31.4 +/- 3.2 ms (P < 0.05). Maximum amplitude augmentation was observed with interstimulus intervals between 2 and 5 ms and in patients with low-amplitude responses after single-pulse stimulation. CONCLUSIONS: Application of paired transcranial electrical stimuli increases amplitudes and reproducibility of tc-MERs during anesthetic-induced depression of the motor system. The effect may represent temporal summation of stimulation at cortical or spinal sites. The results of this study warrant further clinical evaluation of paired transcranial stimulation.

Action Potentials↗

PubMed1996

[Consensus on diagnosis and treatment of the lumbosacral radicular syndrome. Dutch Society for Neurology].

A consensus development meeting concerning the treatment of lumbosacral radicular syndrome (LRS) by entrapment by a herniated disc or spinal stenosis was held on June 9th, 1995. It was observed that there is a lack of good evidence on many aspects of diagnosis and treatment of LRS. Agreement was reached on the thesis that the natural course of LRS is often benign. Diagnosis and treatment can usually be left to the primary care physician. Specialist consultation and ancillary investigations are only needed if an operation is indicated or in case of persistent diagnostic uncertainty. If imaging is needed MRI is preferred to CT or myelography. MRI is highly sensitive, but less specific, and may thus give false-positive results. Neurophysiologic testing may be informative in selected cases. Plain spinal X-rays are not useful in most cases. The traditional non-invasive treatments (such as bedrest, traction, physiotherapy, spinal manipulation) are not based upon convincing scientific evidence. Diagnostic imaging and invasive treatment should be considered in patients with a severe LRS that does not improve within a 4 to 8 week period. Both discectomy and chemonucleolysis are effective treatments. The principal indication is incapacitating radicular pain. There is no sound evidence that the prognosis of paresis is improved by operation. A cauda equina syndrome urgently needs surgical treatment. The efficacy of percutaneous interventions (nucleotomy, laser therapy) has not been proven. There are no strategies for the primary or secondary prevention of LRS that have demonstrated their efficacy. Psychological, social and financial factors probably contribute significantly to the occurrence of persisting symptoms after a LRS. Advice not to work after treatment for LRS may impede rehabilitation.

Diagnostic Imaging↗

PubMedDate not supplied

Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial.

BACKGROUND: Cervical lordosis has been shown to be an important outcome of care; however, few conservative methods of rehabilitating sagittal cervical alignment have been reported. OBJECTIVE: To study whether a seated, retracted, extended, and compressed position would cause tension in the anterior cervical ligament, anterior disk, and muscle structures, and thereby restore cervical lordosis or increase the curvature in patients with loss of the cervical lordosis. STUDY DESIGN: Nonrandomized, prospective, clinical control trial. METHODS: Thirty preselected patients, after diagnostic screening for tolerance to cervical extension with compression, were treated for the first 3 weeks of care using cervical manipulation and a new type of cervical extension-compression traction (vertical weight applied to the subject's forehead in the sitting position with a transverse load at the area of kyphosis). Pretreatment and posttreatment Visual Analogue Scale (VAS) pain ratings were compared along with pretreatment and posttreatment lateral cervical radiographs analyzed with the posterior tangent method for changes in alignment. Results are compared to a control group of 33 subjects receiving no treatment and matched for age, sex, weight, height, and pain. RESULTS: Control subjects reported no change in VAS pain ratings and had no statistical significant change in segmental or global cervical alignment on comparative lateral cervical radiographs (difference in all angle mean values < 1.3 degrees ) repeated an average of 8.5 months later. For the traction group, VAS ratings were 4.1 pretreatment and 1.1 posttreatment. On comparative lateral cervical radiographs repeated after an average of 38 visits over 14.6 weeks, 10 angles and 2 distances showed statistically significant improvements, including anterior head weight bearing (mean improvement of 11 mm), Cobb angle at C2-C7 (mean improvement of -13.6 degrees ), and the angle of intersection of the posterior tangents at C2-C7 (mean improvement of 17.9 degrees ). Twenty-one (70%) of the treatment group subjects were followed for an additional 14 months; improvements in cervical lordosis and anterior weight bearing were maintained. CONCLUSIONS: Chiropractic biophysics (CBP) technique's extension-compression 2-way cervical traction combined with spinal manipulation decreased chronic neck pain intensity and improved cervical lordosis in 38 visits over 14.6 weeks, as indicated by increases in segmental and global cervical alignment. Anterior head weight-bearing was reduced by 11 mm; Cobb angles averaged an increase of 13 degrees to 14 degrees; and the angle of intersection of posterior tangents on C2 and C7 averaged 17.9 degrees of improvement.

Adult↗