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PubMed1993

[Complications of vertebral disc and spinal diseases after manipulation therapy].

Complications caused by manipulation therapy in 3 cases of spine condition and 22 cases of vertebral disc disease observed in relatively short period of time are presented. In the first instance the patients were not diagnosed by physician. In the second one in all cases the nucleus pulposus protruded under the anterior ligament or into the spinal canal. It resulted in marked worsening of the patient's condition. The mechanism of disc damage has been determined intraoperatively. The authors conclude that manual therapy not preceded by precise diagnosis is highly hazardous.

Adolescent↗
PubMed1993

Serotonergic manipulations in experimental neoplastic spinal cord compression.

The effects of differing strategies of serotonergic manipulation on vascular permeability, prostaglandin E2 (PGE2) synthesis, and the clinical course are evaluated in an experimental model of neoplastic spinal cord compression in rats. Serotonergic manipulations include in vivo inhibition of serotonin (5-HT) synthesis by p-chlorophenylalanine (p-CPA) and in vivo blockage of serotonin type 2 (5-HT2) receptors either by the selective antagonist ketanserin or by cyproheptadine. In paralyzed rats, the ratio of 5-hydroxyindole-3-acetic acid (5-HIAA) to 5-HT is significantly elevated in the compressed segments, suggesting that 5-HT utilization is increased. Treatment with p-CPA attenuates spinal 5-HT levels by 62.8% +/- 5.1% (mean +/- standard deviation) and reduces the elevated 5-HIAA:5-HT ratio to the normal value. The increased synthesis of PGE2 observed in the compressed cord is unaffected by p-CPA or ketanserin treatment but is markedly attenuated by cyproheptadine. Ketanserin reduces the 10-fold increase in spinal cord permeability observed in paralyzed rats in a clearly dose-related manner. If given at the first sign of neurological dysfunction, ketanserin delays the onset of paraplegia with the 1-mg/kg dose being clearly superior. Cyproheptadine and p-CPA also reduce the increased permeability and protract the course to paraplegia. A comparison of the effect of dexamethasone, indomethacin, cyproheptadine, p-CPA, and ketanserin reveals that they protract the disease course by 48%, 57%, 60%, 64%, and 78%, respectively. These data suggest that 5-HT2 receptors mediate some of the deleterious vascular consequences observed in the compressed spinal cord by a mechanism not coupled with PGE2 synthesis. A potential benefit of serotonergic manipulations for the acute treatment of neoplastic spinal cord compression is suggested.

Animals↗
PubMed1996

Altered sensory behaviors in mice following manipulation of endogenous spinal adenosine neurotransmission.

Adenosine or adenosine analogs injected intrathecally (i.t.) induce significant antinociception. Recent studies support the existence of an endogenous spinal system that can modulate nociceptive input by releasing adenosine. Inhibition of adenosine metabolism by administration of an adenosine kinase inhibitor, in the present study, decreased behavior induced by putative pain neurotransmitters providing additional support for an endogenous purinergic system. Conversely, administration of high doses of methylxanthines (i.t.), adenosine receptor antagonists, induced behavior similar to that induced by pain neurotransmitters. Methylxanthine (i.t.)-induced behavior was partially inhibited by antagonists of receptors for pain neurotransmitters. These observations are consistent with the hypothesis that an endogenous purinergic system tonically modulates nociceptive input involving a variety of chemical mediators. Preliminary studies also revealed methylxanthine-induced allodynia and suggested spinal purinergic systems may have a broader role in discriminating sensory input.

Adenosine↗
PubMed2002

A rigid body model of the dynamic posteroanterior motion response of the human lumbar spine.

BACKGROUND: Clinicians apply posteroanterior (PA) forces to the spine for both mobility assessment and certain spinal mobilization and manipulation treatments. Commonly applied forces include low-frequency sinusoidal oscillations (<2 Hz) as used in mobilization, single haversine thrusts (<0.5 seconds) as imparted in high-velocity, low-amplitude (HVLA) manipulation, or very rapid impulsive thrusts (<5 ms) such as those delivered in mechanical-force, manually-assisted (MFMA) manipulation. Little is known about the mechanics of these procedures. Reliable methods are sought to obtain an adequate understanding of the force-induced displacement response of the lumbar spine to PA forces. OBJECTIVE: The objective of this study was to investigate the kinematic response of the lumbar spine to static and dynamic PA forces. DESIGN: A 2-dimensional modal analysis was performed to predict the dynamic motion response of the lumbar spine. METHODS: A 5-degree-of-freedom, lumped equivalent model was developed to predict the PA motion of the lumbar spine. Lumbar vertebrae were modeled as masses, massless-spring, and dampers, and the resulting equations of motion were solved by using a modal analysis approach. The sensitivity of the model to variations in the spring stiffness and damping coefficients was examined, and the model validity was determined by comparing the results to oscillatory and impulsive force measurements of vertebral motion associated with spine mobilization and 2 forms of spinal manipulation. RESULTS: Model predictions, based on a damping ratio of 0.15 (moderate damping) and PA spring stiffness coefficient ranging from 25 to 60 kN/m, showed good agreement with in vivo human studies. Quasi-static and low-frequency (<2.0 Hz) forces at L3 produced L3 segmental and L3-L4 intersegmental displacements up to 8.1 mm and 3.0 mm, respectively. PA oscillatory motions were over 2.5-fold greater for oscillatory forces applied at the natural frequency. Impulsive forces produced much lower segmental displacements in comparison to static and oscillatory forces. Differences in intersegmental displacements resulting from impulsive, static, and oscillatory forces were much less remarkable. The latter suggests that intersegmental motions produced by spinal manipulation may play a prominent role in eliciting therapeutic responses. CONCLUSIONS: The simple analytical model presented in this study can be used to predict the static, cyclic, and impulsive force PA displacement response of the lumbar spine. The model provides data on lumbar segmental and intersegmental motion patterns that are otherwise difficult to obtain experimentally. Modeling of the PA motion response of the lumbar spine to PA forces assists in the understanding the biomechanics of therapeutic PA forces applied to the lumbar spine and may ultimately be used to validate chiropractic technique procedures and minimize risk to patients receiving spinal manipulative therapy.

Biomechanical Phenomena↗
PubMed2001

Patient positioning and spinal locking for lumbar spine rotation manipulation.

High velocity low amplitude (HVLA) thrust techniques are widely used by many manual therapists to treat low back pain. There is increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain. HVLA thrust techniques are associated with an audible release in the form of a pop or cracking sound that is widely accepted to represent cavitation of a spinal zygapophyseal joint. This audible release distinguishes these techniques from other manual therapy interventions. When using long lever HVLA thrust techniques spinal locking is necessary to localize forces and achieve cavitation at a specific vertebral segment. A critical factor in applying lumbar spine manipulation with minimal force is patient positioning and spinal locking. A knowledge of coupled movements of the lumbar spine aids an understanding of the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation. Excessive rotation can result in pain, patient resistance and failed technique. This masterclass presents a model of patient positioning for the lumbar spine that minimizes excessive use of rotation to achieve spinal locking prior to the application of the thrust.

Contraindications↗
PubMed2005

Intracranial hypotension induced by cervical spine chiropractic manipulation.

STUDY DESIGN: Case report. OBJECTIVES: We report a case of intracranial hypotension ensuing after a spinal chiropractic manipulation leading to cerebrospinal fluid (CSF) isodense effusion in the upper cervical and thoracic spine. SUMMARY OF BACKGROUND DATA: The etiology of intracranial hypotension is not fully understood, but CSF leakage from spinal meningeal diverticula or dural tears may be involved. METHODS: A 36-year-old woman presented with neck and both shoulder pain 4 days earlier. She undertook a spinal chiropractic manipulation. After this maneuver, she complained of a throbbing headache with nausea and vomiting. Her headache worsened, and lying down gave the only measure of limited relief. In CSF study, it showed dry tapping. Brain MRI showed pachymeningeal gadolinum enhancement. Thoracic spine MRI showed CSF leakage. After admission to the hospital, she was treated by hydration and pain control over several days. However, her headache did not improve. RESULTS: She was treated by epidural blood patch. Afterwards, her headache was improved. This is the first case of spontaneous intracranial hypotension in which spinal chiropractic manipulation coincided with the development of symptoms and in which a CSF collection in the upper cervical and thoracic spine was demonstrated radiographically in Korea. CONCLUSIONS: From this case, we can understand the etiology of intracranial hypotension and consider the complication of chiropractic manipulation.

Adult↗
PubMed1996

Dorsal laminectomy in the adult mouse: a model for nervous system research.

Animal strains with specific genetic mutations can serve as powerful tools to study normal and pathologic cellular and molecular processes. The mammalian species with the largest number of known genetic mutations is the mouse. In spinal cord research, mice have not been used as extensively as other species because of the difficulty in accessing and manipulating their spinal cord. We describe the technique of exposing and manipulating the spinal cord of normal mice and of mice with the severe combined immunodeficiency (scid) mutation. Surgical outcome and complications are discussed. We conclude that dorsal laminectomy with subsequent access and manipulation of the spinal cord and its roots can be accomplished consistently with practice.

Animals↗
PubMed2003

Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord.

Joint manipulation has long been used for pain relief. However, the underlying mechanisms for manipulation-related pain relief remain largely unexplored. The purpose of the current study was to determine which spinal neurotransmitter receptors mediate manipulation-induced antihyperalgesia. Rats were injected with capsaicin (50 microl, 0.2%) into one ankle joint and mechanical withdrawal threshold measured before and after injection. The mechanical withdrawal threshold decreases 2 h after capsaicin injection. Two hours after capsaicin injection, the following drugs were administered intrathecally: bicuculline, blocks gamma-aminobutyric acid (GABAA) receptors; naloxone, blocks opioid receptors; yohimbine blocks, alpha2-adrenergic receptors; and methysergide, blocks 5-HT(1/2) receptors. In addition, NAN-190, ketanserin, and MDL-72222 were administered to selectively block 5-HT1A, 5-HT2A, and 5-HT3 receptors, respectively. Knee joint manipulation was performed 15 min after administration of drug. The knee joint was flexed and extended to end range of extension while the tibia was simultaneously translated in an anterior to posterior direction. The treatment group received three applications of manipulation, each 3 min in duration separated by 1 min of rest. Knee joint manipulation after capsaicin injection into the ankle joint significantly increases the mechanical withdrawal threshold for 45 min after treatment. Spinal blockade of 5-HT(1/2) receptors with methysergide prevented, while blockade of alpha2-adrenergic receptors attenuated, the manipulation-induced antihyperalgesia. NAN-190 also blocked manipulation-induced antihyperalgesia suggesting that effects of methysergide are mediated by 5-HT1A receptor blockade. However, spinal blockade of opioid or GABAA receptors had no effect on manipulation induced-antihyperalgesia. Thus, the antihyperalgesia produced by joint manipulation appears to involve descending inhibitory mechanisms that utilize serotonin and noradrenaline.

Adrenergic alpha-Antagonists↗
PubMed2004

A preclinical post laminectomy rat model mimics the human post laminectomy syndrome.

Chronic low back pain with sciatica complicating post laminectomy surgery is poorly understood. It is likely that some aspects of persistent pain of the syndrome results from spinal facilitation in which there is lowering of pain excitation levels. A small animal preclinical model is needed that mimics the clinical condition to permit detailed studies of the underlying altered neurochemistry of the sensory pathways. We propose herein a rat laminectomy model containing the elements required for study of the neurobiology of the condition. The model consists of a surgical laminectomy that includes L5 spinal nerve manipulation and disc injury, elements necessarily employed in human disc herniation surgery. At 8 weeks post laminectomy the proposed model demonstrates paraspinous muscle spasm, tail contracture, behavioral pain behavior, tactile allodynia, epidural and nerve root scarring, and nerve root adherence by scar to the underlying disc and adjacent pedicle. Two underlying pain facilitation states are invoked in the clinical condition: (1) an inflammatory state required to achieve wound healing; and (2) a nerve injury state resulting from nerve manipulation and subsequent epidural scarring, spinal nerve scarring, and spinal nerve tethering to the adjacent disc and pedicle. Both pain facilitation states are active in the model.

Analysis of Variance↗
PubMed1997

Dorsal spondylodesis of unstable thoracolumbar fractures by a far-lateral approach to the disc.

This paper describes a modified and less traumatic approach to the thoracolumbar spine and compares it with standard techniques for instrumented spinal fusion. Ten patients with unstable fractures of the thoracolumbar spine were included in the open prospective investigation, and were treated by a surgical technique consisting of a dorsolateral approach to the injured segment, filling the disk space and the fractured vertebra with autologous bone, and transpedicular fixation with an AO internal fixator. All patients were followed for 6 to 12 months after surgery by clinical tests and spinal X-rays. Excellent short-term and long-term results were obtained. A stable bony fusion was achieved in all cases, and a minimal mean decrease of 2 degrees in the kyphosis angle was found at late follow-up. No major complications related to the procedure were encountered, and no worsening of neurological deficits occurred after surgery. In conclusion, the far-lateral approach to the thoracolumbar spine yields results which are equivalent or better than those of standard techniques. Major advantages of our procedure, as evaluated in this rather small group of patients, are selective immobilization of the injured segment without involvement of functionally intact spinal levels, no manipulations within the spinal canal boundaries, and relatively limited exposure of the spine.

Adult↗
PubMed2006

Posterolateral spinal cord decompression in patients with metastasis: an endoscopic assisted approach.

Spinal tumors that are radioresistant or cause bony compression of the spinal cord often require surgical decompression to protect or restore neurological function. Metastatic lesions and primary tumors such as multiple myeloma usually arise in the vertebral body, which can collapse and become unstable, and can compress the anterior columns of the cord. Laminectomy is often ineffective in these patients, and direct anterior decompression through thoracotomy is the widely-accepted solution to the neurological problem. The anterior surgical approach is particularly challenging in the upper thoracic spine. Patients with limited pulmonary reserve due to pneumonectomy or pulmonary metastasis might not tolerate the loss of lung capacity necessitated by either thoracotomy or thoracoscopy. Because posterior instrumentation is usually needed to provide stability following corpectomy and spinal cord decompression, posterolateral approaches to spinal cord decompression have gained favor in recent years. Posterolateral decompression offers advantages over the combined anterior and posterior approach, reducing operative time, morbidity, and hospital stay. Drawbacks to traditional posterolateral decompressions include poor visualization of the tumor immediately anterior to the spinal cord and the need to manipulate the spinal cord to completely remove a tumor adherent to the dura. Endoscopically assisted posterolateral decompression allows decompression of the anterior surface of the spinal cord, the point of pressure in most circumstances. Endoscopic video assistance facilitates vertebrectomy, cord decompression, and anterior reconstruction, all performed through the same posterior incision. Endoscopic assisted spinal cord decompression dramatically reduces morbidity, ICU requirements, and inpatient hospitalization and has proven useful for a variety of metastatic tumors at every level of the spinal column.

Adolescent↗