DISC HERNIATION AND CHIROPRACTIC
 
   

Disc Herniation and Chiropractic

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.


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FROM:   “Specific Potentialities of the Subluxation Complex
Chapter 7 of   R. C. Schafer's “Basic Principles of Chiropractic Neuroscience



The Cellular and Molecular Biology of the Intervertebral Disc:
A Clinician’s Primer

J Can Chiropr Assoc. 2014 (Sep);   58 (3):   246–257 ~ FULL TEXT

Clinicians routinely encounter patients suffering from both degenerative and acute spinal pain, often as a consequence of pathology affecting the intervertebral disc (IVD). The IVD is a complex structure essential to spinal function and is subject to degenerative disease and injury. However, due to the complexity of spinal pain syndromes it is often difficult to determine the extent of the IVD’s contribution to the genesis of spinal pain. The location of the IVD is within close proximity to vital neural elements and may in the event of pathological change or injury compromise those structures. It is therefore important that clinicians performing manual therapy understand the cellular and molecular biology of the IVD as well as its clinical manifestation of degeneration/injury in order to safely manage and appreciate the role played by the disc in the development of mechanical spinal pain syndromes.


The Radiculopathy and Chiropractic Page
Explore this collection of articles that demonstrates that conservative chiropractic care is both safe and effective for the relief of radicular pain.



Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging–Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up
J Manipulative Physiol Ther 2014 (Mar);   37 (3):   155-163

Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported.


Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up
J Manipulative Physiol Ther 2013 (Oct);   36 (8):   461–467

50 adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. At 2 weeks, 55.3% were "improved," 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001).   Of the subacute/chronic patients, 76.2% were improved at 3 months.


Early Adolescent Lumbar Intervertebral Disc Injury:
A Case Study

Chiropractic & Manual Therapies 2013 (Apr 26);   21:   13

This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included.


Manipulation or Microdiskectomy for Sciatica?
A Prospective Randomized Clinical Study

J Manipulative Physiol Ther. 2010 (Oct);   33 (8):   576–584

One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months.   Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.


Cost and Use of Conservative Management of
Lumbar Disc Herniation Before Surgical Discectomy

Spine J. 2010 (Jun);   10 (6):   463–468

Lumbar discectomy is one of the most common spine surgical procedures. The average charge for discectomy procedure was $7,841. Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate. This study reviewed the costs associated with various conservative measures.


The Effect of Backpacks on the Lumbar Spine in Children:
A Standing Magnetic Resonance Imaging Study

SPINE (Phila Pa 1976) 2010 (Jan 1);   35 (1):   83–88

This is the first study to use advanced imaging to demonstrate how backpack loads are responsible for a significant amount of back pain in children, which in part, may be due to changes in lumbar disc height or curvature. This is the first upright MRI study to document reduced disc height and greater lumbar asymmetry for common backpack loads in children.


Cervical Myelopathy:
A Case Report of a “Near-Miss” Complication
to Cervical Manipulation

J Manipulative Physiol Ther 2008 (Sep);   31 (7):   553—557

Cases have been reported in which radiculopathy or myelopathy secondary to herniated disk has occurred after cervical manipulation. In each case, it is not possible to determine whether the neurologic symptoms and signs were directly caused by the manipulation or whether they developed as part of the natural history of the disorder. The purpose of this article is to report a case in which a patient with radiculopathy secondary to herniated disk was scheduled to receive manipulation but just before receiving this treatment developed acute myelopathy.


Improvement of Lower Extremity Electrodiagnostic Findings Following
a Trial of Spinal Manipulation and Motion-based Therapy

Chiropractic & Osteopathy 2006 (Sep 12);   14:   20 ~ FULL TEXT

An elderly male patient presented to a private spine clinic with right-sided foot drop. He had been prescribed an ankle-foot orthosis for this condition. All sensory, motor, and reflex findings in the right leg and foot were absent. This was validated on prior electromyography and nerve conduction velocity testing, performed by a board certified neurologist. Patient was treated using spinal manipulation twice-weekly and wobble chair exercises three times daily for 90 days total. Following this treatment, the patient was referred for follow-up electrodiagnostic studies. Significant improvements were made in these studies as well as self-rated daily function.
There are more studies like this at the CHIROPRACTIC CASE REPORTS Page.


Manipulation in the Presence of Cervical Spinal Cord Compression:
A Case Series

J Manipulative Physiol Ther 2006 (Mar);   29 (3):   236—144

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.


Chiropractic High-velocity Low-amplitude Spinal Manipulation
in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome

J Manipulative Physiol Ther 2004 (Nov);   27 (9):   574—578

A 35-year-old woman presented with complaints of midback pain, low-back pain, buttock pain, saddle anesthesia, and bladder and bowel incontinence, all of 6 months duration. The patient was 6 months post emergency surgery for acute cauda equina syndrome due to lumbar disc herniation. She had been released from neurosurgical care with the current symptoms considered to be residual and nonprogressive.   The patient was treated with high-velocity low-amplitude spinal manipulation and ancillary myofascial release. After 4 treatments, the patient reported full resolution of midback, low back, and buttock pain. The patient was seen another 4 times with no improvement in her neurologic symptoms. No adverse effects were noted.


Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations:
A Systematic Review and Risk Assessment

J Manipulative Physiol Ther 2004 (Mar);   27 (3):   197–210

Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.   An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.


Single-blind Randomised Controlled Trial of Chemonucleolysis
and Manipulation in the Treatment of Symptomatic Lumbar Disc Herniation

Eur Spine J 2000 (Jun);   9 (3):   202–207

Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. In this study it was shown that for managing disc herniations, the cost of treatment failures following a medical course of treatment [chymopapain injections] averaged 300 British pounds per patient, while there were no such costs following spinal manipulation.


Is It Safe to Adjust the Cervical Spine in the Presence of a
Herniated Disc?

Dynamic Chiropractic – June 12, 2000

I am often asked by chiropractors, medical doctors and patients if manipulation of the cervical spine is safe in the presence of a cervical herniated nucleus pulposis (CHNP). I usually answer that in most circumstances it not only is safe, but it is often an essential aspect of treatment. I will clarify what this means and provide some of the evidence that supports this notion. I will also illustrate that in most of cases that require treatment, manipulation alone is not a sufficient approach, but that some form of rehabilitation is necessary.


Manipulative Therapy in Lower Back Pain With Leg Pain and
Neurological Deficit

J Manipulative Physiol Ther 1998 (May);   21 (4):   288—294

The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.


Treatment of Cervical Disc Protrusions Via Instrumental
Chiropractic Adjustment

J Manipulative Physiol Ther 1998 (Feb);   21 (2):   114—121

The patient was initially treated with high-velocity manual manipulation of the cervical spine and reported a subsequent aggravation of her symptoms. Thereafter, she was treated with short-lever, mechanical-force, manually-assisted chiropractic adjusting procedures to the cervical spine, utilizing an Activator Adjusting Instrument. She tolerated the treatment well and subsequently experienced a complete resolution of the presenting symptoms.


Magnetic Resonance Imaging and Clinical Follow-up: Study of
27 Patients Receiving Chiropractic Care for Cervical
and Lumbar Disc Herniations

J Manipulative Physiol Ther 1996 (Nov);   19 (9):   597—606

Clinically, 80% of the patients studied had a good clinical outcome with postcare visual analog scores under 2 and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. There was a statistically significant association (p < .005) between the clinical and MRI follow-up results. Seventy-eight percent of the patients were able to return to work in their predisability occupations.


Chiropractic Treatment of Cervical Radiculopathy Caused by
a Herniated Cervical Disc

J Manipulative Physiol Ther 1994 (Feb);   17 (2):   119—123

Conservative treatment including chiropractic manipulative therapy seems to be a reasonable alternative to surgery, for cervical radiculopathy caused by a herniated cervical disc. Clinical trials should be performed to evaluate long term success rate, risk of permanent disability, rate of recovery and cost effectiveness of this and other forms of treatment for cervical radiculopathy caused by herniated nucleus pulposus.findings.


Chiropractic Management and Manipulative Therapy for MRI
Documented Cervical Disk Herniation

J Manipulative Physiol Ther 1994 (Mar);   17 (3):   177—185

The patients were prescribed a treatment regimen consisting of chiropractic management including bracing, physiotherapy, cervical manipulative procedures, traction and exercises. The patients responded well to care as evidence by posttreatment MRI, electrodiagnostic studies, clinical exam findings and thermography scan findings. Patients with and without nerve root compression secondary to cervical disk herniation can and do respond well to chiropractic care. Chiropractic management of this condition can and should be employed prior to more invasive treatment.



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