PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Manipulation, Spinal”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources
PubMedDate not supplied

Manipulation in the presence of cervical spinal cord compression: a case series.

OBJECTIVE: The purpose of this study is to present information from a series of patients with imaging findings of encroachment on the cervical spinal cord who were treated with chiropractic cervical manipulation. CASE SERIES: There were 27 patients (18 females, 9 males; age range, 23-65, mean age, 44.3 years) with neck and/or arm pain with findings of cervical spinal cord encroachment on magnetic resonance imaging. None of these patients had severe or acute myelopathy or advanced signal changes in the spinal cord indicative of myelomalacia. These patients were treated with a variety of approaches that included some form of cervical manipulation. The mean number of treatments that included manipulation was 12 (range, 2-32). Nineteen patients were treated with high-velocity, low-amplitude "thrust" manipulation, 9 patients were treated with low-velocity muscle energy technique, and 1 patient was treated with both methods. The mean patient-rated subjective improvement at the last follow-up reexamination was 70.0% (range, 10%-100%). From baseline to the last follow-up examination, the mean improvements in outcome measures were as follows: Bournemouth Neck Disability Questionnaire, 23.7 points (31%); Neck Disability Index, 6.4 points; and Numerical Pain Rating Scale, 3.9 points. In 3 patients, there was increased pain after manipulation that lasted from 1 to 4 days. There were no major complications, and in no patient did any increased pain after treatment last more than 4 days. No new neurologic symptoms or signs were seen in any of these patients. CONCLUSION: The finding of cervical spinal cord encroachment on magnetic resonance imaging, in and of itself, should not necessarily be considered an absolute contraindication to manipulation. However, because radicular and myelopathic complications to cervical manipulation have been reported in the literature, great care should be taken in all cases, particularly those in which anatomic conditions such as cord encroachment are present.

Adult↗
PubMed2000

Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin.

BACKGROUND: Manipulation under joint anesthesia/analgesia (MUJA) is an approach to treatment for patients with chronic, recalcitrant spinal axis pain of synovial joint origin. MUJA is the synthesis of fluoroscopically and corticosteroid agents with targeted, manual mobilizations and/or manipulations of the injected joint(s). DISCUSSION: MUJA should be viewed with guarded optimism because its success is based solely on anecdotal experience. Many physicians (specializing in targeted intraarticular "blocks" of spinal synovial joints) and chiropractors (specializing in manual mobilization and manipulation of spinal synovial joints) in the Tyler, Texas, area have treated more than 1000 patients over a 7-year period with the MUJA protocol. This protocol includes treatment of the atlanto-occipital and lateral atantoaxial joints of the upper cervical spine, the zygapophysial joints of the cervical spine from C2-3 to C6-7, the thoracic spine and the lumbar spine, and the pelvic sacroiliac joints. CONCLUSION: The following patient types are suitable candidates for MUJA: patients with dominant spinal axis pain who have been unable to progress despite the passage of sufficient time (>2 months) and the delivery of prior treatments, including spinal manipulative therapy; patients with pain so severe that standard manipulative therapy cannot be delivered with technical success; and patients with complex problems in whom the diagnosis of synovial joint-mediated spinal pain must be established before the safe delivery of manipulative therapy.

Analgesics↗
PubMed1998

Closed reduction of bilateral locked facets of the cervical spine under general anaesthesia.

BACKGROUND: Bilateral facet interlocking of the cervical spine is a relatively uncommon type of cervical spinal injury. It is frequently associated with devastating neurological symptoms and signs. Early reduction of the locked facets is thought to be critical in preventing progressive secondary spinal cord injury. Whereas skull tong traction remains our primary option for closed reduction of bilateral locked facets of the cervical spine, it is not always successful, even with heavy traction weights. Other more aggressive measures may occasionally be required. The authors report their experience in reducing bilateral locked facets of the cervical spine by manual closed reduction. METHODS: This small series consists of six cases of cervical spinal injury with bilateral locked facets in which manual closed reduction under general anaethesia and muscle relaxation was used. Three of them presented with complete quadriplegia (Frankel class A). One case presented with incomplete but severe neurological deficits (Frankel class B). After unsuccessful closed reduction with skull traction, these patients were treated by manual closed reduction under general anaesthesia and muscle relaxation, followed by anterior discectomy, interbody fusion and stabilization. RESULTS: All cases made neurological improvement after the procedures. Even in cases with initial severe neurological deficits, the recovery was remarkable. The recovery was dramatic in two cases. Case 1 improved from Frankel class B to E; and Case 5 from Frankel class A to D. No case deteriorated neurologically after the procedures. Pneumonia occurred in Case 3; and stress ulcer accompanied by haemorrhage was noted in Case 4. None of these complications was directly related to the procedures. CONCLUSION: The potential for improvement of neurological function following early and successful reduction and fixation of the dislocated spine is emphasized. With meticulous techniques, manual closed reduction may be an effective alternative to skull tong traction when the latter fails.

Adult↗
PubMed2004

Spontaneous hemorrhage into spinal neurenteric cyst.

CASE REPORT: A case of spontaneous hemorrhage into an intradural extramedullary neurenteric cyst at the C4-C6 level in a 6-year-old boy is reported. The child presented with sudden neck pain, torticollis, and myelopathy. The cyst was of high signal intensity on both T1- and T2-weighted magnetic resonance images, suggesting hemorrhage into the cyst. The combination of CT and MR provided useful preoperative information regarding the nature and the location of the cyst. A posterior approach via osteoplastic laminotomy was used for this anteriorly localized cyst. The use of intraoperative ultrasound was helpful in identifying and puncturing the cyst to minimize the spinal cord manipulation during the excision of the cyst wall. DISCUSSION: We report the first documented case of hemorrhage into a spinal neurenteric cyst that has been confirmed surgically and histopathologically.

Child↗
PubMed2005

Development of a rat model of amyotrophic lateral sclerosis expressing a human SOD1 transgene.

Mutations in copper-zinc superoxide dismutase gene (SOD1) have been linked to some familial cases of ALS. We report here that rats that express a human SOD1 transgene with two different ALS-associated mutations (G93A and H46R) develop striking motor neuron degeneration and paralysis. By comparing the two transgenic rats with different SOD1 mutations, we demonstrate that the time course in these rats was similar to human SOD1-mediated familial ALS. As in the human disease and transgenic ALS mice, pathological analysis shows selective loss of motor neurons in the spinal cords of these transgenic rats. In addition, typical neuronal Lewy body-like hyaline inclusions as well as astrocytic hyaline inclusions identical to those in human familial ALS are observed in the spinal cords. The larger size of this rat model as compared with the ALS mice will facilitate studies involving manipulations of spinal fluid (implantation of intrathecal catheters for chronic therapeutic studies; CSF sampling) and spinal cord (e.g., direct administration of viral- and cell-mediated therapies).

Amyotrophic Lateral Sclerosis↗
PubMed2001

Spinal cord decompression: an endoscopically assisted approach for metastatic tumors.

STUDY DESIGN: The paper describes a technique for complete vertebrectomy and spinal cord decompression, followed by a formal anterior column reconstruction, using endoscopic instruments. This procedure is indicated for patients with radioresistant metastasis of the thoracic spine, particularly those involving the upper thoracic segments where a thoracotomy is difficult and carries a high morbidity, and for patients with pulmonary disease who cannot tolerate a standard thoracotomy. Results in nine consecutive cases are reported. OBJECTIVES: To demonstrate the feasibility and benefits of endoscopically assisted decompression and stabilization through a single, extrapleural, posterolateral approach. SETTING: The Cleveland Clinic, Cleveland, Ohio, USA. METHODS: Posterolateral decompression of the thoracic spinal cord offers potential advantages over traditional combined procedures (anterior thoracotomy and posterior instrumentation), including reduced operative time, decreased morbidity, and reduced hospital stay. Previous studies have not demonstrated the same neurological benefit for posterolateral decompression as for anterior vertebrectomy and decompression, however, Surgical indications, rationale and technique for an improved posterolateral approach, augmented by endoscopic methods, are provided, and initial clinical results are described. RESULTS: Drawbacks to the traditional posterolateral decompressions have included poor visualization of the spinal cord and anterior tumor, poor access to tumor on the side contralateral to the approach, and the need to manipulate the spinal cord to completely remove both adjacent tumor and tumor adherent to the dura. Transpedicular decompression using endoscopy is described in nine patients. The mean operative time for the combined procedure was 6.0 h, with a mean blood loss of 1677 cc. Neurological recovery and maintenance were excellent. Inpatient days averaged 6.5, and ICU days averaged 1.4. Two patients died of disease eight and 14 months post-op, and seven were living, with disease, 3-36 months after surgery. CONCLUSIONS: Endoscopically assisted decompression can reduce morbidity, hospitalization, and treatment costs while matching the efficacy of traditional combined procedures. Endoscopy provides a readily available and easily applied tool that dramatically improves the surgeon's vision, providing light, magnification, and a direct view of remote structures.

Decompression, Surgical↗
PubMed1998

Endoscopically assisted decompression for metastatic thoracic neoplasms.

STUDY DESIGN: The author describes a technique for complete vertebrectomy and anterior decompression followed by a formal anterior column reconstruction, using readily available endoscopic instruments. This procedure is indicated in patients with radioresistant metastasis of the thoracic spine, particularly those involving the upper thoracic segments where a thoracotomy is difficult and causes a high rate of morbidity. This is also a suitable technique for patients with pulmonary disease who cannot tolerate a standard thoracotomy. OBJECTIVES: To demonstrate the feasibility and potential benefits of endoscopically controlled decompression through an extrapleural, posterolateral approach. SUMMARY OF BACKGROUND DATA: Posterolateral decompression of the thoracic spine offers potential advantages in comparison with traditional anterior-posterior procedures combining thoracotomy and posterior instrumentation, including decreased operative time, decreased morbidity, and reduced hospital stay. Results of previous studies have not demonstrated the same benefit for posterolateral decompression as for anterior vertebrectomy and decompression. Drawbacks to the traditional posterolateral decompressions have included poor visualization of the spinal cord and anterior tumor, poor access to tumor on the side contralateral to the approach, and the need to manipulate the spinal cord to completely remove adjacent tumor and tumor adherent to the dura. METHODS: Surgical indications, rationale, and technique are provided, and initial clinical results are described. RESULTS: Transpedicular decompression using endoscopy is described in five patients. The mean operative time for the combined procedure was 7.25 hours, with a mean blood loss of 1800 mL. Neurologic recovery and maintenance were excellent. Inpatient days averaged 7.5, and intensive care days averaged 2. One patient died of disease 8 months after surgery, and four were living, with disease, 3-24 months after surgery. CONCLUSIONS: Endoscopically assisted decompression can reduce morbidity, hospital stay, and treatment costs while matching the efficacy of traditional combined procedures. Endoscopy provides a readily available and easily applied tool that dramatically improves the surgeon's vision, providing light, magnification, and a direct view of remote structures.

Bone Nails↗
PubMed1999

Back problems. Chiropractic evaluation and management.

A thorough knowledge of equine spinal anatomy, biomechanics, and potential pathology is required to understand the principles and theories behind chiropractic and to apply its techniques properly. Chiropractic provides additional diagnostic and therapeutic means that may help equine practitioners to identify and treat the primary cause of lameness or poor performance. Specialized training in the evaluation and treatment of vertebral joint dysfunction and neuromusculoskeletal disorders places chiropractic in the forefront of conservative treatment of spinal-related disorders. Nevertheless, limited research is currently available on equine chiropractic and other nontraditional modalities in veterinary medicine. In 1996, the American Veterinary Medicine Association's Committee on Alternative and Complementary Therapies suggested that the research community should be encouraged to prioritize avenues of research and to allocate research funds to projects that are designed to provide further scientific evaluation of these modalities. The future of equine chiropractic in veterinary medicine is dependent on future research into the clinical effects of chiropractic techniques and the basic pathophysiology of spinal-related disorders in horses.

Animals↗
PubMedDate not supplied

[Systems analysis of X-ray films of the vertebral column].

The systems analysis of spinal X-ray films (SASXF) developed by the author solves the problem of an integral and, concurrently, detailed study of the spine of a patient on the basis of routine X-ray study. The examination of the patient gave rise to a patient's systems spinal model that considers the individual features of the vertebral column, which are most significant for a manual therapist's work. The standards of a X-ray study, a protocol form, and examination tools are described. An example of systems spinal model is given. The experience accumulated during studies of more than 2000 patients has shown that this procedure is highly effective in implementing medical manipulations by the methods of manual therapy.

Adult↗
PubMedDate not supplied

[Systems analysis of X-ray films of the vertebral column].

The systems analysis of spinal X-ray films (SASXF) developed by the author solves the problem of an integral and, concurrently, detailed study of the spine of a patient on the basis of routine X-ray study. The examination of the patient gave rise to a patient's systems spinal model that considers the individual features of the vertebral column, which are most significant for a manual therapist's work. The standards of a X-ray study, a protocol form, and examination tools are described. An example of systems spinal model is given. The experience accumulated during studies of more than 2000 patients has shown that this procedure is highly effective in implementing medical manipulations by the methods of manual therapy.

Humans↗
PubMed1990

Chiropractic adjustive manipulation on subjects with acute low back pain: visual analog pain scores and plasma beta-endorphin levels.

The purpose of this study was to evaluate pain scores and plasma beta-endorphin levels following a single spinal adjustive manipulation in subjects with acute low back pain. Eighteen subjects were randomly assigned to either a control group, which received no treatment; a sham group, which received only light physical contact (touch); or an experimental group, which received an adjustive manipulation at a specific lumbar segment. Following a standard protocol, all subjects were administered visual analog pain scales and venous blood was drawn 5 min prior to, 5 min after, and 30 min after intervention. Analysis of the pain scores indicated that there was a slight, but significant, reduction of pain in the experimental group, but no similar reduction in the control or sham groups. Furthermore, this reduction of pain in the experimental group was not accompanied any significant change in the plasma beta-endorphin concentration.

Adult↗
PubMed1981

Pathway selection by embryonic chick motoneurons in an experimentally altered environment.

To characterize cues used by motoneuron axons to reach their appropriate targets, connectivity patterns within the embryonic chick hindlimb have been analysed after early experimental manipulations of the limb or spinal cord. The manipulations altered the anterior-posterior (a.-p.) relationship between motoneurons within the lumbosacral motor column and their specific targets in the limb. Primary emphasis was placed on analysing the pathways taken by embryonic motoneuron axons at stages 23-36 which had been orthogradely labelled by horseradish peroxidase (HRP) injection into the motor column. Motoneuron pool topography and functional patterns of connectivity were also identified by retrograde HRP labelling and spinal cord stimulation coupled with electromyographic recording. With small shifts in position, as in two or three segment a.-p. cord reversals or a.-p. limb shifts, motoneuron axons frequently entered the appropriate plexus but in an inappropriate spinal nerve sequence. Despite this, axons altered their course to innervate specifically and consistently their current target. When motoneuron axons entered an inappropriate plexus as the result of a greater positional shift (i.e. more extensive cord reversal or limb shift) or in experiments where posterior cord segments were replaced with anterior cord segments and supernumerary limbs were added, they behaved in one of two ways. They either formed inappropriate and largely unpatterned or unordered connections or they took totally aberrant paths within the limb to reach their appropriate target. We conclude that axons are capable of responding in a precise and specific manner to environmental cues when displaced up to a certain distance from their target or normal point of entry into the limb. Their failure to form patterned connections at more extreme distances suggests that the cues to which they are responding may be local, or that an axon's ability to respond to them is restricted to subclasses of the motoneuron population.

Animals↗
PubMedDate not supplied

Chiropractic management of a patient with subluxations, low back pain and epileptic seizures.

OBJECTIVE: To describe the chiropractic management of a patient presenting with complaints of low back pain and epileptic seizures. The discussion also addresses epilepsy and the current concepts of this disorder; possible mechanisms for the neurological effects of the chiropractic adjustment at sites of subluxation and its therapeutic implications are proposed. CLINICAL FEATURES: A 21-year-old woman with low back pain reported that she had fainted during the night and hit her head. She had been diagnosed since childhood with grand mal (tonicclonic) seizures as well as petit mal seizures. She had a seizure approximately every 3 hr, with a duration between 10 sec and 30 min for each episode. Examination indicated signs of subluxation/dysfunction at the L5-S1, C6-C7 and C3-C4 spinal levels. There was no evidence of cranial nerve involvement or any upper motor neuron lesion. Radiographic analysis revealed retrolisthesis of L5, hypolordosis of the cervical spine and hyperextension of the C6-C7 motion segment. INTERVENTION AND OUTCOME: Chiropractic adjustments using a specific-contact, short-lever arm, high-velocity, low-amplitude maneuver (i.e., Gonstead) were applied to the subluxations at the cervical, thoracic and lumbopelvic region. The patient's reported low back pain and neck complaints improved and her seizure frequency decreased. At 1.5-yr follow-up, the patient reported her low back complaints had resolved and her seizures had decreased (period between seizures as great as 2 months). CONCLUSION: Results encourage further investigation of possible neurological sequalae, such as epileptic seizures, from spinal dysfunction identified as vertebral subluxation complexes by chiropractors and treated by specific spinal adjustments.

Adult↗
PubMed1997

Intraoperative control by somatosensory evoked potentials in the treatment of cervical myeloradiculopathy. Results in 210 cases.

Somatosensory evoked potentials (SEPs) were used for continuous monitoring of 210 patients during anterior surgery for cervical myeloradiculopathy, to test how effectively they help avoid irreversible neurological damage during surgery. The pathologies differed in severity and were treated by diskectomy or by extended corporectomy using the Senegas technique. Intraoperative SEP changes were recorded in 84 patients (40%); in 13 (6.2%) of these, changes in SEP amplitude and latency were caused by mechanical stress. SEPs revealed transient episodes of regional ischaemia or neurophysiological anomalies during anaesthesia (mainly hypotension) in 27 patients (12.8%). The traces detected incipient and potentially dangerous mechanical pressure on, or metabolic anomalies of, the spinal cord during manipulation and placement procedures of spinal fixation devices. They were particularly sensitive indicators of ischaemia; one of the most common causes of irreversible injury. The traces of 44 patients (21.0%) improved markedly during surgery. There were no false-negatives in this series and, thanks to the fact that SEPs gave immediate warnings of incipient ischaemia to the surgical team, we had no case of irreversible medullary or nerve-root deficit.

Adult↗
PubMed2005

The anterior approach to anterior cervical meningiomas: review illustrated by a case.

Anterior cervical meningiomas have traditionally been operated on by a posterior approach. However, several reports of an anterior approach to anterior cervical meningiomas and other anterior cervical intradural lesions have documented important advantages: large bony window of access, extradural coagulation of anterior blood supply to meningiomas, visualization of the intradural pathology in front of the spinal cord, and absence of manipulation of the spinal cord during resection of the lesion. In this study, the literature about anterior approaches to anterior cervical meningiomas is systematically reviewed and the advantages and disadvantages of the technique are discussed. Furthermore, a case of complete resection of a large anterior cervical intradural extramedullary meningioma from C5-7 by a three-level corpectomy with progressive postoperative neurological recovery is illustrated, confirming the advantages of the anterior approach.

Aged↗