Shaping conservative spinal services with the Spine Tango Registry.

PURPOSE: This study reports the results of a registry data collection project within a secondary care spinal osteopathy service. METHODS: Clinical and demographic data were collected using the Spine Tango Conservative registry data collection tool. Outcomes were assessed using the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Neck Disability Index (NDI), COMI Low Back Conservative (COMI-LBC), COMI Neck Conservative (COMI-NC) and EQ5D. Global treatment outcome (GTO), satisfaction with care and therapeutic complications were reported using the Spine Tango Patient Self Assessment form (STPSA). The correlation of GTO and PROM change scores was analysed using Spearman's rank correlation coefficient. RESULTS: 262 patients presented during the study period. 100% of patients had chronic spinal pain and 98.8% had previously received other interventions for the same episode. Mean (standard deviation) improvements by PROM: NPRS low back 2.1 (2.5); NPRS neck 2.3 (2.3); COMI-LBC 2.1 (2.2); COMI-NC 2.0 (1.7); ODI 10.5 (12.1); NDI 14.5 (12.2); EQ5D 0.2 (0.3). 83.2% of patients reported that osteopathy had 'helped a lot' or 'helped'. 96.2% of patients were 'very satisfied' or 'satisfied' with care. There were no serious therapeutic complications. CONCLUSIONS: The secondary care spinal osteopathy service demonstrated high satisfaction, few therapeutic complications and positive outcomes on all PROMs. Registry participation has facilitated robust clinical governance and the data support the use of osteopaths to deliver a conservative spinal service in this setting. Registry data collection is a significant administrative and clinical task which should be structured to minimise burden on patients and resources. These slides can be retrieved under Electronic Supplementary Material.

Clinical outcome following anterior arthrodesis in patients with presumed sacroiliac joint pain.

BACKGROUND: It has been reported that in 13-32% of patients with chronic low back pain, the pain may originate in the sacroiliac (SI) joints. When treatment of these patients with analgesics and physiotherapy has failed, a surgical solution may be discussed. Results of such surgery are often based on small series, retrospective analyses or studies using a minimal invasive technique, frequently sponsored by manufacturers. PURPOSE: To report the clinical outcome concerning pain, function and quality of life following anterior arthrodesis in patients presumed to have SI joint pain using validated questionnaires pre- and post-operatively. An additional aim was to describe the symptoms of the patients included and the preoperative investigations performed. MATERIAL AND METHODS: Over a 6 year period we treated 55 patients, all women, with a mean age of 45 years (range 28-65) and a mean pelvic pain duration of 9.1 years (range 2-30). The pain started in connection with minor trauma in seven patients, pregnancy in 20 and unspecified in 28. All patients had undergone long periods of treatment including physiotherapy, manipulation, needling, pelvic belt, massage and chiropractic without success, and 15 had been operated for various spinal diagnoses without improvement. The patients underwent thorough neurological investigation, plain X-ray and MRI of the spine and plain X-ray of the pelvis. They were investigated by seven clinical tests aimed at indicating pain from the SI joints. In addition, all patients underwent a percutaneous mechanical provocation test and extra-articular local anaesthetic blocks against the posterior part of the SI joints. Before surgery all patients answered the generic Short-Form-36 (SF-36) questionnaire, the disease specific Balanced Inventory for Spinal Disorders (BIS) questionnaire and rated their level of pelvic and leg pain (VAS, 0-100). At follow-up at a mean of 2 years 49 patients completed the same questionnaires (89%). RESULTS: At follow-up 26 patients reported a lower level of pelvic pain than before surgery, 16 the same level and six a higher level. Applying Svensson's method RPpelvic pain=0.3976, with 95% CI (0.2211, 0.5740) revealed a statistically significant systematic improvement in pelvic pain. At follow-up 28 patients reported a higher quality of life and 26 reported sleeping better than pre-operatively. In most patients the character of the pelvic pain was dull and aching, often accompanied by a stabbing component in connection with sudden movements. Referred pain down the leg/s even to the feet and toes was noted by half of the patients and 29 experienced frequency of micturition. CONCLUSIONS: It is apparent that in some patients the SI joints may cause long-term pain that can be treated by arthrodesis. We speculate that continued pain despite a healed arthrodesis may be due to persistent pain from adjacent ligaments. The next step should be a prospective randomized study comparing posterior fusion and ligament resection with non-surgical treatment. IMPLICATIONS: Anterior arthrodesis can apparently relieve pain in some patients with presumed SI joint pain. The problem is how to identify these patients within the low back pain group.

Test-Retest Reliability of Measuring the Vertebral Arterial Blood Flow Velocity in People With Cervicogenic Dizziness.

OBJECTIVES: The purpose of this study was to determine the within-session and between-sessions reliability of measuring the vertebral artery blood flow velocities in people with cervicogenic dizziness using Doppler ultrasound at both upper and lower cervical levels. METHODS: Outcome measures were taken on 2 occasions 3 weeks apart with no active treatment provided in between the assessments on 12 participants. Pulsed-wave Doppler ultrasound was used to quantify time-averaged mean velocities through the vertebral artery at upper cervical (C0-1) and lower cervical vertebrae (C5-6). The clinical outcome measures were also recorded in people with cervicogenic dizziness. The intraclass correlation coefficient (ICC) was used to determine the within-session and between-session repeatability. Paired t test was used to determine the differences in the time-averaged mean velocities of blood flow at the same site of the vertebral artery and the clinical outcome measures in 2 sessions 3 weeks apart. RESULTS: In people with cervicogenic dizziness, there was no significant change in both clinical outcome measures and the time-averaged mean velocities when the patients were measured 3 weeks apart (P > .05). This study identified good within-session (ICC: 0.903-0.967) and between-session (ICC: 0.922-0.984) repeatability in measuring the vertical blood flow velocities in patients with cervicogenic dizziness when the clinical outcome measures were unchanged. CONCLUSIONS: This study supports the use of Doppler ultrasound to identify changes in mean vertebral arterial blood flow velocities before and after intervention in people with cervicogenic dizziness in future studies.

Treating low back pain resulted from lumbar degenerative instability using Chinese Tuina combined with core stability exercises: A randomized controlled trial.

BACKGROUND: The therapeutic effect of Tuina combined with core stability exercises on low back pain resulted from lumbar degenerative instability is unclear. This article aims to evaluate whether core stability exercises can improve the effect of Tuina in this regard. METHODS: This trial was designed as a randomized controlled trial and carried out in Qingzhou hospital of Traditional Chinese medicine between June 2011 and June 2013. Eighty-eight patients with low-grade lumbar degenerative instability were included and divided randomly into experimental and control groups, 44 in each. The experimental group were treated using Tuina combined with core stability exercises, but the control group using Tuina alone. The evaluation of Visual analogue scale (VAS), Japanese Orthopaedic Association scores (JOA) and recurrence rate were performed. RESULTS: Two weeks after treatment, JOA scores increased (p<0.05) and VAS decreased (p<0.05) significantly when compared with those before treatment in both groups, but there was no significant difference (p>0.05) between the two groups. At the end of six weeks, VAS scores (p<0.05) decreased and JOA scores (p<0.05) increased significantly when compared to those before treatment in both groups. In addition, the VAS (p<0.05) scores were significantly lower, JOA scores (p<0.05) were significantly higher in experimental group than those in control group. At the final follow-up, seven cases (17.1%) in experimental group and eighteen (43.9%) in control group recurred, the control group has a significantly higher recurrence rate (p<0.05). No adverse events occurred in the trial. CONCLUSIONS: Chinese Tuina combined with core stability exercises has better effect than Tuina alone in treating low back pain resulted from low-grade lumbar degenerative instability.

Fluoroscopy-guided infiltration for pain reduction in patients with Baastrup's disease: clinical experience and results.

OBJECTIVE: Baastrup disease refers to degenerative changes of adjacent spinous processes with resultant back pain. The purpose of this study is to assess the safety and efficacy of percutaneous, fluoroscopy-guided infiltrations in a consecutive series of patients suffering from Baastrup disease. MATERIALS AND METHODS: From January 2009 until December 2013, 55 patients suffering from Baastrup disease (diagnosed clinically and by imaging findings) underwent percutaneous, fluoroscopy-guided infiltration. The position of the needle (22-gauge spinal needle) was fluoroscopically verified at the level of interspinous ligament. Then a mixture of long-acting corticosteroid with local anesthetic (1.5/1 cc) was injected. A questionnaire with NVS scale helped in assessing pain relief degree, life quality, and mobility improvement. RESULTS: In the patients of our study, a total of 67 sessions was performed. In 12/55 patients (22%), a second infiltration was performed within 7-10 days apart from the first one. The end point was 1 year post-treatment. Patients were followed 1 week after the first injection for a subsequent treatment and then if asymptomatic re-controlled in 3-6 and 12 months. Comparing the pain scores prior (mean value, 8.18 ± 1.44 NVS units) and after (mean value, 0.62 ± 0.93 NVS units) there was a mean decrease of 7.56 ± 1.68 NVS units (p < 0.001) on terms of pain reduction, effect upon mobility and life quality. There were no clinically significant complications noted in our study. CONCLUSIONS: Fluoroscopy-guided infiltrations seem to be a feasible, efficacious, and safe approach for pain reduction and mobility improvement in patients with Baastrup disease.

Feasibility of nerve stimulator as a supplemental aid for lumbar transforaminal epidural block.

BACKGROUND: The purpose of this study was to evaluate the clinical feasibility of an electric nerve stimulator in a lumbar transforaminal epidural block. METHODS: Using an electric nerve stimulator, transforaminal epidural blocks were performed in 105 segments of 49 patients who presented with lower back pain with radiating pain to lower extremities. The contrast medium was injected to delineate the nerve root after positioning an insulated needle at the intervertebral foramen under fluoroscopic guidance. Then, the nerve root was electrically stimulated with the insulated needle to confirm whether or not the same radiating pain was evoked. RESULTS: Of the 105 foraminal segments, the same radiating pain was evoked at 0.5 mAh in 47 segments (44.8%), at 1.0 mAh in 22 (21.0%), at 1.5 mAh in 3 (2.9%), at 2.0 mAh in 15 (14.3%), at 2.5 mAh in 4 (3.8%), and at 3.0 mAh in 5 (4.8%). No response was observed in 9 segments (8.6%). The fluoroscopy revealed successful positioning of the needle in the patients with an evoked radiating pain over 2.0 mAh. The visual analogue scale (VAS) obtained for pain improved from a mean of 7.5 to 2.7 after the block (p = 0.001). In the 9 cases without response to electrical stimulation, the patients showed an improvement on VAS from 7.8 to 3.4 (p= 0.008) also. CONCLUSIONS: A nerve stimulator can help to predict the accuracy of needle positioning as a supplemental aid for a successful lumbar transforaminal epidural block. It is sufficient to initiate a proper stimulation amplitude of the nerve at 2 mAh.

Comparison of mulligan sustained natural apophyseal glides and maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial.

BACKGROUND: There is short-term evidence for treatment of cervicogenic dizziness with Mulligan sustained natural apophyseal glides (SNAGs) but no evidence for treatment with Maitland mobilizations. OBJECTIVE: The purpose of this study was to compare the effectiveness of SNAGs and Maitland mobilizations for cervicogenic dizziness. DESIGN: A double-blind, parallel-arm randomized controlled trial was conducted. SETTING: The study was conducted at a university in Newcastle, Australia. PARTICIPANTS: Eighty-six people with cervicogenic dizziness were the study participants. INTERVENTIONS: Included participants were randomly allocated to receive 1 of 3 interventions: Mulligan SNAGs (including self-administered SNAGs), Maitland mobilizations plus range-of-motion exercises, or placebo. MEASUREMENTS: The primary outcome measure was intensity of dizziness. Other outcome measures were: frequency of dizziness, the Dizziness Handicap Inventory (DHI), intensity of pain, and global perceived effect (GPE). RESULTS: Both manual therapy groups had reduced dizziness intensity and frequency posttreatment and at 12 weeks compared with baseline. There was no change in the placebo group. Both manual therapy groups had less dizziness intensity posttreatment (SNAGs: mean difference=-20.7, 95% confidence interval [95% CI]=-33.6, -7.7; mobilizations: mean difference=-15.2, 95% CI=-27.9, -2.4) and at 12 weeks (SNAGs: mean difference=-18.4, 95% CI=-31.3, -5.4; mobilizations: mean difference=-14.4, 95% CI=-27.4, -1.5) compared with the placebo group. Compared with the placebo group, both the SNAG and Maitland mobilization groups had less frequency of dizziness at 12 weeks. There were no differences between the 2 manual therapy interventions for these dizziness measures. For DHI and pain, all 3 groups improved posttreatment and at 12 weeks. Both manual therapy groups reported a higher GPE compared with the placebo group. There were no treatment-related adverse effects lasting longer than 24 hours. LIMITATIONS: The therapist performing the interventions was not blind to group allocation. CONCLUSIONS: Both SNAGs and Maitland mobilizations provide comparable immediate and sustained (12 weeks) reductions in intensity and frequency of chronic cervicogenic dizziness.

Feasibility of Nerve Stimulator as a Supplemental Aid for Lumbar Transforaminal Epidural Block

BACKGROUND: The purpose of this study was to evaluate the clinical feasibility of an electric nerve stimulator in a lumbar transforaminal epidural block. METHODS: Using an electric nerve stimulator, transforaminal epidural blocks were performed in 105 segments of 49 patients who presented with lower back pain with radiating pain to lower extremities. The contrast medium was injected to delineate the nerve root after positioning an insulated needle at the intervertebral foramen under fluoroscopic guidance. Then, the nerve root was electrically stimulated with the insulated needle to confirm whether or not the same radiating pain was evoked. RESULTS: Of the 105 foraminal segments, the same radiating pain was evoked at 0.5 mAh in 47 segments (44.8%), at 1.0 mAh in 22 (21.0%), at 1.5 mAh in 3 (2.9%), at 2.0 mAh in 15 (14.3%), at 2.5 mAh in 4 (3.8%), and at 3.0 mAh in 5 (4.8%). No response was observed in 9 segments (8.6%). The fluoroscopy revealed successful positioning of the needle in the patients with an evoked radiating pain over 2.0 mAh. The visual analogue scale (VAS) obtained for pain improved from a mean of 7.5 to 2.7 after the block (p = 0.001). In the 9 cases without response to electrical stimulation, the patients showed an improvement on VAS from 7.8 to 3.4 (p = 0.008) also. CONCLUSIONS: A nerve stimulator can help to predict the accuracy of needle positioning as a supplemental aid for a successful lumbar transforaminal epidural block. It is sufficient to initiate a proper stimulation amplitude of the nerve at 2 mAh.

Survey of inspection and palpation rates among spine providers: evaluation of physician performance of the physical examination for patients with low back pain.

STUDY DESIGN: Survey from July 2011 to April 2012 of adult patients with primary complaint of low back pain (LBP). OBJECTIVE: To determine the frequency of physical examination being performed by various providers, as measured by frequency of inspection and palpation, of patients with LBP and to describe patient ratings of these examinations. SUMMARY OF BACKGROUND DATA: The physical examination is a cornerstone of any evaluation of patients with LBP. With increasing reliance on diagnostic imaging, there is concern that patients are not being examined comprehensively, but to our knowledge, no studies have ever investigated how often the physical examination is performed in patients with LBP. METHODS: Survey participants were asked to list the types of physicians that they had seen for LBP within the past 1 year and for each physician encounter to answer 2 "yes/no" questions: (1) whether they had removed their clothes or put on a gown or shorts during the examination (our proxy for inspection) and (2) whether the provider had placed his or her hands on the patient (our proxy for palpation). Subjects also provided quality ratings for each provider's physical examination. Main outcome measures included frequency of inspection and palpation and subjects' ratings of each physical examination. RESULTS: A total of 295 surveys were collected reflecting 696 prior physician encounters. Inspection was done in 57% of physician encounters. Across specialties, orthopedic surgeons had the highest reported rate of inspection at 72%. The worst was among chiropractors at 40%. Palpation occurred in 80% of physician encounters. Chiropractors had the highest rate of palpation at 94%. The lowest rate was among neurosurgeons at 58%. CONCLUSION: Our data suggest that approximately 43% of patient visits for LBP involved no inspection and nearly 20% without palpation. These numbers reflect a need for improvement among providers who treat patients with LBP. LEVEL OF EVIDENCE: N/A.

Cervical syndrome - the effectiveness of physical therapy interventions.

INTRODUCTION: The cervical syndrome refers to a set of disorders caused by the changes in the cervical spine and the soft-tissue surrounding it, with pain as the predominant symptom. Sore neck has been a common problem among a large section of today`s population. The factors contributing to this issue include the modern lifestyle, prolonged sitting and incorrect, fixed or constrained working postures. The root of these difficulties is found in the mechanical disorders of the cervical spine structures, poor body posture and jerky body movements. In the Scandinavian countries neck pain is considered to be a public health problem. METHODS: The study evaluated 25 patients with an established diagnosis of cervical syndrome. The research was conducted at the PI Institute of Occupational and Sports Medicine of Zenica-Doboj Canton. Each patient received twenty physical therapy treatment sessions. RESULTS AND CONCLUSIONS: The study included 25 patients suffering from the cervical syndrome. The statistical analysis of gender distribution indicated that 36% of the patients were male, while 64% were female. The mean age of study participants was 46.76±4,23. The patients ranged in age from 39 to 54 years, with no statistically significant difference in the mean age of male and female patients, p=0.691. Analysing the types of occupational activities performed by the patients, the study found a positive relation between neck pain and prolonged sitting at work. The patients who performed office work made up 76% of the total number. Each method of physical therapy applied in the treatment of neck pain patients proved useful. However, the combination of electrotherapy, kinesiotherapy and manual massage proved to be most effective. CONCLUSION: The cervical syndrome is a common medical condition primarily affecting adult population, with prevalence being higher among women and office workers. The condition places a considerable socioeconomic burden on the afflicted. Cervical pain ranges greatly in severity - from moderate to unbearable, thus leading to high levels of work absence as well as to a decrease in the quality of life. Proper physical therapy program can help the patients with neck pain return to their normal everyday activities, improve their quality of life, as well as reduce the absence from work.

[Alternating and pulsed magnetic fields for the treatment of dorsopathies].

The therapeutic application of isolated low-intensity magnetic field pulses (magnetic induction 150 mT) results in the significant improvement of the initial tone of microvessels and their vasomotor activity. The application of double pulses of the high-energy magnetic field (magnetic induction 1300 mT per pulse) stimulates the activity of the peripheral neuromuscular apparatus due to an enhancement of the initially low muscular tone and contractility. Moreover, it decreases the degree of manifestation of the functional state of peripheral nerves. These data suggest the necessity of the differential approach to the choice of parameters of the magnetic field being applied taking into account the initial clinical and functional characteristics of neurological dorsopathic syndromes.

MRI features of spinal cord decompression sickness presenting as a Brown-Sequard syndrome.

Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of spinal cord decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining.

The basis for spinal manipulation: chiropractic perspective of indications and theory.

It is reasonable to think that patients responding to spinal manipulation (SM), a mechanically based therapy, would have mechanical derangement of the spine as a critical causal component in the mechanism of their condition. Consequently, SM practitioners routinely assess intervertebral motion, and treat patients on the basis of those assessments. In chiropractic practice, the vertebral subluxation has been the historical raison d'etre for SM. Vertebral subluxation is a biomechanical spine derangement thought to produce clinically significant effects by disturbing neurological function. This paper reviews the putative mechanical features of the subluxation and three theories that form the foundation for much of chiropractic practice. It concludes with discussion of subluxation as an indicator for SM therapy, particularly from the perspective that subluxation may be one contributory cause of ill-health within a "web of causation".

Is spinal cord stimulation an effective treatment option for discogenic pain?

INTRODUCTION: In a prospective observational study conducted in an urban pain management center, we evaluated whether spinal cord stimulation (SCS) is effective in relieving discogenic pain of IDD origin. METHODS: Thirteen patients with intractable discogenic low back pain were enrolled. Four patients never underwent permanent implantation due to insurance denial, medical reasons or failed trial and served as a control group. Nine patients underwent SCS implantation (treatment group). All patients were followed for 12 months and assessed at each interval for pain (NRS), disability (ODI), and opioid use. RESULTS: Nine patients completed the SCS trial with > 50% pain relief. The pretrial NRS score was 7.8 ± 0.5 mm in treated patients vs. 6.5 ± 1.7 mm in control patients. At 3, 6 and 12 months, the NRS was reduced to 2.9 ± 0.7 mm, 1.7 ± 0.5 mm, and 2.9 ± 0.5 mm, respectively in treated patients. NRS was unchanged in the control patients (6.5 ± 1.9 mm). The ODI score prior to the SCS trial in treated patients was 53.1 ± 3.4% vs. 54.0 ± 20.5 in control patients. At 3, 6 and 12 months the ODI scores were 39.0 ± 8.0%, 38.7 ± 4.6%, and 41.1 ± 3.9%, respectively in the treated patients, and 48.5 ± 29.5 at 12 months in control patients. In 6 patients receiving opioids prior to the SCS trial, average consumption was reduced by 69% (P = 0.036) over 12 months of therapy as compared with a 54% increase in the control patients. SCS usage was stable over the 12-month study. CONCLUSIONS: The current study indicates that SCS may provide effective pain relief, improve disability, and reduce opioid usage in patients with discogenic pain.

Basis for spinal manipulative therapy: a physical therapist perspective.

Physical therapists internationally provide spinal manipulative therapy (SMT) to patients with musculoskeletal pain complaints. SMT has been a part of physical therapist practice since the profession's beginning. Early physical therapist clinical decision making for SMT was influenced by the approaches of osteopathic and orthopedic physicians at the time. Currently a segmental clinical decision making approach and a responder clinical decision making approach are two of the more common models through which physical therapist clinical use of SMT is directed. The focus of segmental clinical decision making is upon identifying a dysfunctional vertebral segment with the application of SMT to restore mobility and/or alleviate pain. The responder clinical decision making approach attempts to categorize individuals based on a pattern of signs and symptoms suggesting a likely positive response to SMT. The present manuscript provides an overview of common physical therapist clinical decision making approaches to SMT and presents areas requiring further study in order to optimize patient response.

Pain reduction of acupoint electrical stimulation for patients with spinal surgery: a placebo-controlled study.

BACKGROUND: Acupoint electrical stimulation (AES) is commonly used for pain management. However, its true or placebo effect to achieve pain relief needs to be verified. OBJECTIVE: This study aimed to examine the true effect of AES to reduce postoperative pain in patients with spinal surgery receiving patient-controlled analgesia (PCA). METHOD: A placebo- and sham-controlled study was conducted. Participants were randomly assigned to intervention with AES at true acupoints (the AES group, n=30), AES at sham acupoints (the sham group, n=30), or no intervention with AES (the control group, n=30). Outcomes were assessed according to the amount of pain experienced and analgesics used. RESULTS: There were significant differences among the three groups in pain relief across time, and the occurrence of PCA button pushed and amount of analgesics used. The beneficial effects of AES were discernible when compared to the sham and the control. CONCLUSIONS: AES at the true acupoints effectively reduced postoperative pain and analgesic usage. AES has now been implemented into healthcare and it is recommended that nurses be provided with the opportunity to earn their AES skills. More studies evaluating the effects of AES over a longer period and on pain after different surgical procedures are suggested.

Oxygen-ozone therapy for degenerative spine disease in the elderly: a prospective study.

We describe our experience of oxygen-ozone therapy to treat degenerative spine disease in the elderly. From April 2004 to March 2008 we selected 129 patients with CT and/or MR evidence of spondyloarthrosis and disc degeneration of the lumbar spine. All patients enrolled in the study had contraindications to the administration of commonly used analgesic and anti-inflammatory drugs.Oxygen-ozone therapy was given by CT-guided intraforaminal injection as the first treatment followed by 4 weekly paralumbar infiltrations on an outpatient basis. The full treatment lasted a month. Clinical outcome was assessed 3 months and 1 year after treatment. The good results obtained indicate that oxygen-ozone therapy is an ideal treatment with no side-effects in elderly patients with degenerative spine disease.

[Dysmenorrhea induced by lumbosacral spine disorders. Pathogenesis, diagnosis and therapy with special emphasis on spinal manipulative therapy]. / Dismenoreja izazvana poremecajima lumbosakralne kraljeznice. Patogeneza, dijagnoza i terapija s posebnim naglaskom na spinalnu manipulativnu terapiju.

Dysmenorrhea (painful menstruation), which can be primary or secondary, is a common gynecological problem. Primary dysmenorrhea (normal gynecological finding) is caused by increased production of uterine prostaglandins. Namely, under the influence of hormonal changes and vegetative factors at the end of a menstrual cycle, in numerous girls and women with a normal gynecological finding, vasoconstriction in small uterine arteries and endometrial ischemia occur, resulting in excessive prostaglandins synthesis in endometrial cells. Local effect of prostaglandins on the uterus is manifested by painful uterine contractions during menstruation. Prostaglandins can cause general symptoms too (headache, nausea, vomiting, diarrhea, urinary frequency) because they are released from endometrial cells and they reach the systemic circulation (increased plasma levels of prostaglandins, particularly F2 alpha prostaglandin). Nonsteroidal anti-inflammatory drugs are established as initial therapy for women with primary dysmenorrhea; besides that, oral contraceptives and other prescription drugs are taken into consideration as well as different forms of complementary therapy. In 20-25% of cases, the reduction of pain is not achieved by use of standard therapy. Clinical experiences have shown that significant pain regression during a menstrual cycle has been often achieved by the use of spinal manipulative therapy (SMT) indicated in women with primary dysmenorrhea with coexisting functional disorders of lumbosacral (LS) spine. Namely, by activation of the nociceptive and vegetative system, LS spine disorders, before all segmental dysfunction and degenerative changes, can induce referred pain and reflex disturbances of pelvic organs (somatovisceral reflexes). Since significant improvement or disappearance of pain during a menstrual cycle is often achieved with adequate therapy of coexisting vertebral disorders in women with primary dysmenorrhea, it is important to recognise latent or manifest vertebral disorders in dysmenorrheic women using clinical examination.