Symptomatic, MRI Confirmed, Lumbar Disc Herniations: A Comparison of Outcomes Depending on the Type and Anatomical Axial Location of the Hernia in Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation

Abstract Objective The purpose of this study was to evaluate whether specific MRI features, such as axial location and type of herniation, are associated with outcomes of symptomatic lumbar disc herniation patients treated with spinal manipulation therapy (SMT). Methods MRI and treatment outcome dat...

Full description

Saved in:
Bibliographic Details
Published in:Journal of manipulative and physiological therapeutics 2016-03, Vol.39 (3), p.192-199
Main Authors: Ehrler, Marco, B. Med, Peterson, Cynthia, DC, M.Med.Ed, Leemann, Serafin, DC, Schmid, Christof, DC, Anklin, Bernard, DC, Humphreys, B. Kim, DC, PhD
Format: Article
Language:English
Subjects:
Analysis of Variance
Female
Humans
Intervertebral Disc Displacement
Intervertebral Disc Displacement - pathology
Intervertebral Disc Displacement - therapy
Leg
Low Back Pain - pathology
Low Back Pain - therapy
Lumbar Vertebrae
Lumbar Vertebrae - pathology
Magnetic Resonance Imaging
Male
Manipulation
Pain Management
Patient Positioning
Physical Medicine and Rehabilitation
Prospective Studies
Spinal
Spine
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Objective The purpose of this study was to evaluate whether specific MRI features, such as axial location and type of herniation, are associated with outcomes of symptomatic lumbar disc herniation patients treated with spinal manipulation therapy (SMT). Methods MRI and treatment outcome data from 68 patients were included in this prospective outcomes study. Pain numerical rating scale (NRS) and Oswestry physical disability questionnaire (OPDQ) levels were measured at baseline. The Patients Global Impression of Change scale, the NRS and the OPDQ were collected at 2 weeks, 1, 3, 6 months and 1 year. One radiologist and 2 chiropractic medicine master’s degree students analyzed the MRI scans blinded to treatment outcomes. κ statistics assessed inter-rater reliability of MRI diagnosis. The proportion of patients reporting relevant improvement at each time point was compared based on MRI findings using the chi-square test. The t test and ANOVA compared the NRS and OPDQ change scores between patients with various MRI abnormalities. Results A higher proportion of patients with disc sequestration reported relevant improvement at each time point but this did not quite reach statistical significance. Patients with disc sequestration had significantly higher reduction in leg pain at 1 month compared to those with extrusion ( P = .02). Reliability of MRI diagnosis ranged from substantial to perfect (K = .733-1.0). Conclusions Patients with sequestered herniations treated with SMT to the level of herniation reported significantly higher levels of leg pain reduction at 1 month and a higher proportion reported improvement at all data collection time points but this did not reach statistical significance.
ISSN:0161-4754
1532-6586
DOI:10.1016/j.jmpt.2016.02.013