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1.
Medicine (Baltimore) ; 98(49): e18135, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804324

RESUMO

BACKGROUND: Degenerative lumbar spondylolisthesis (DLS) is one of the common orthopedic diseases which causes low back pain in patients, which seriously affects people's daily life and work. As a method of conservative treatment of this disease, manipulation is widely used in clinical practice. We will summarize the current published evidence of manipulation in the treatment of DLS, and evaluate the effectiveness and safety of manipulation through systematic review and meta-analysis, so as to provide more reliable evidence for future clinical practice. METHODS: We will conduct a comprehensive search of the following 9 databases until January 2019: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, Wan Fang Database, and Chinese Biomedical Database. The 2 researchers will independently search, screen, extract data, and evaluate the quality of the literatures. The primary outcomes include clinical effectiveness, Japanese Orthopaedic Association scores, and the secondary outcomes include visual analog scale scores, symptom scores, and adverse events. Bias risk tools provided by Cochrane Collaboration will be used for literature quality assessment, and RevMan 5.3 software will be used for meta-analysis. RESULTS: The results of this study will systematically evaluate the effectiveness and safety of manipulation intervention for people with DLS, especially in improving lumbar function scores and pain scores. CONCLUSION: The systematic review of this study will summarize the current published evidence of manipulation for the treatment of DLS, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION: This study does not require ethical approval and the results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019139933.


Assuntos
Vértebras Lombares , Manipulação da Coluna/métodos , Espondilolistese/terapia , Humanos , Manipulação da Coluna/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
2.
Chiropr Man Therap ; 27: 41, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31548880

RESUMO

Background: Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing self-neck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis. Case presentation: A 63-year-old man presented to the emergency department with worsening interscapular pain radiating to his neck 1 day after performing self-manipulation of his cervical spine. He was found to be coagulopathic upon admission, secondary to chronic warfarin therapy for the management of atrial fibrillation. Approximately 48 h after the manipulation, the patient became acutely quadriparetic and hypotensive. Urgent magnetic resonance imaging revealed a multilevel spinal epidural hematoma from the lower cervical to thoracic spine. Conclusions: Partial C7, complete T1 and T2, and partial T3 bilateral laminectomy was performed for evacuation of the spinal epidural hematoma. Following a 2-week course of acute inpatient rehabilitation, the patient returned to his baseline functional status. This case highlights the risks of self-manipulation of the neck and potentially other activities that significantly stretch or apply torque to the cervical spine. It also presents a clinical scenario in which practitioners of spinal manipulation therapy should be aware of patients undergoing anticoagulation therapy.


Assuntos
Hematoma Epidural Espinal/cirurgia , Manipulação da Coluna/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/etiologia , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Varfarina/uso terapêutico
3.
Medicina (Kaunas) ; 55(8)2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394861

RESUMO

Background and Objectives: Spinal manipulations are interventions widely used by different healthcare professionals for the management of musculoskeletal (MSK) disorders. While previous theoretical principles focused predominantly on biomechanical accounts, recent models propose that the observed pain modulatory effects of this form of manual therapy may be the result of more complex mechanisms. It has been suggested that other phenomena like neurophysiological responses and the activation of the immune-endocrine system may explain variability in pain inhibition after the administration of spinal manipulative therapy (SMT). The aim of this paper is to provide an overview of the available evidence supporting the biological plausibility of high-velocity, low-amplitude thrust (HVLAT) on the immune-endocrine system. Materials and Methods: Narrative critical review. An electronic search on MEDLINE, ProQUEST, and Google Scholar followed by a hand and "snowballing" search were conducted to find relevant articles. Studies were included if they evaluated the effects of HVLAT on participants' biomarkers Results: The electronic search retrieved 13 relevant articles and two themes of discussion were developed. Nine studies investigated the effects of SMT on cortisol levels and five of them were conducted on symptomatic populations. Four studies examined the effects of SMT on the immune system and all of them were conducted on healthy individuals. Conclusions: Although spinal manipulations seem to trigger the activation of the neuroimmunoendocrine system, the evidence supporting a biological account for the application of HVLAT in clinical practice is mixed and conflicting. Further research on subjects with spinal MSK conditions with larger sample sizes are needed to obtain more insights about the biological effects of spinal manipulative therapy.


Assuntos
Sistema Endócrino/fisiologia , Sistema Imunitário/fisiologia , Manipulação da Coluna/efeitos adversos , Manipulação da Coluna/métodos , Sistema Endócrino/inervação , Sistema Endócrino/metabolismo , Humanos , Sistema Imunitário/inervação , Sistema Imunitário/metabolismo , Manejo da Dor/métodos , Manejo da Dor/normas , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Resultado do Tratamento
4.
World Neurosurg ; 128: 182-185, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31078801

RESUMO

BACKGROUND: Traumatic spinal subdural hematoma is an extremely rare occurrence that requires urgent investigation and most often prompt intervention. To our knowledge, this is the first reported case related to a spinal manipulative therapy. CASE DESCRIPTION: This report describes a case of traumatic lumbar subdural hematoma after a spinal manipulative therapy without any predisposing factor. A 23-year-old man was admitted to the emergency department for partial cauda equina syndrome after a spinal manipulation performed by a physiotherapist. Magnetic resonance imaging showed an acute spinal subdural hematoma at L2-L3 level with cauda equina compression. The patient underwent an emergency L2 laminectomy with evacuation of the hematoma. He recovered completely his neurologic functions after 1 week. CONCLUSION: Practitioners of spinal manipulations should be aware of spinal subdural hematoma as a possible complication. A rapid diagnosis with magnetic resonance imaging is mandatory, and emergency surgical decompression is usually the optimal treatment for spinal subdural hematomas with severe neurologic deficit.


Assuntos
Síndrome da Cauda Equina/etiologia , Hematoma Subdural Espinal/etiologia , Manipulação da Coluna/efeitos adversos , Paraplegia/etiologia , Síndrome da Cauda Equina/diagnóstico por imagem , Síndrome da Cauda Equina/cirurgia , Descompressão Cirúrgica , Emergências , Humanos , Laminectomia , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Paraplegia/diagnóstico por imagem , Paraplegia/cirurgia , Adulto Jovem
5.
Biomed Res Int ; 2019: 3793840, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30863777

RESUMO

Background: The safety of cervical rotatory manipulation (CRM) is still controversial, especially in patients with carotid artery atherosclerosis (CAS). The study aimed to investigate the effects of CRM on carotid plaques in vulnerability. Methods: 50 rabbits were randomly divided into four groups: model rabbits with CRM [CAS-CRM (n=15)]; model rabbits without CRM [CAS (n=15)]; normal rabbits with CRM [Normal-CRM (n=10)]; and Blank-control group (n=10). CAS disease models were induced by carotid artery balloon injury combined with a high-fat diet for 12 weeks. Then, CRM technique was performed in CAS-CRM and Normal-CRM groups for 3 weeks. In the end, determination of serum level of hs-CRP and Lp-PLA2, histological analysis under HE and Masson trichromic staining, and immunohistochemical analysis with CD34 and CD68 antibody were completed in order. Results: Carotid stenosis rates on successful model rabbits ranged from 70% to 98%. The CAS-CRM group had an increased level of hs-CRP (P<0.05), in comparison with the CAS group, whereas effects were not significant between the Normal-CRM group and Blank-control group. In comparison with the CAS group, the positive expression of CD34 and CD68 in the CAS-CRM group increased significantly (P<0.05). Conclusion: CRM therapy may increase the vulnerability of carotid plaque in rabbits with severe CAS.


Assuntos
Oclusão com Balão/efeitos adversos , Proteína C-Reativa/genética , Doenças das Artérias Carótidas/cirurgia , Manipulação da Coluna/efeitos adversos , Placa Aterosclerótica/cirurgia , Animais , Antígenos CD34/genética , Proteína C-Reativa/metabolismo , Artérias Carótidas/metabolismo , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Lesões das Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/fisiopatologia , Lesões das Artérias Carótidas/cirurgia , Dieta Hiperlipídica , Modelos Animais de Doenças , Regulação da Expressão Gênica/genética , Humanos , Placa Aterosclerótica/sangue , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/fisiopatologia , Coelhos
6.
BMJ ; 364: l689, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30867144

RESUMO

OBJECTIVE: To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting. REVIEW METHODS: Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence. The effect of SMT was compared with recommended therapies, non-recommended therapies, sham (placebo) SMT, and SMT as an adjuvant therapy. Main outcomes were pain and back specific functional status, examined as mean differences and standardised mean differences (SMD), respectively. Outcomes were examined at 1, 6, and 12 months. Quality of evidence was assessed using GRADE. A random effects model was used and statistical heterogeneity explored. RESULTS: 47 randomised controlled trials including a total of 9211 participants were identified, who were on average middle aged (35-60 years). Most trials compared SMT with recommended therapies. Moderate quality evidence suggested that SMT has similar effects to other recommended therapies for short term pain relief (mean difference -3.17, 95% confidence interval -7.85 to 1.51) and a small, clinically better improvement in function (SMD -0.25, 95% confidence interval -0.41 to -0.09). High quality evidence suggested that compared with non-recommended therapies SMT results in small, not clinically better effects for short term pain relief (mean difference -7.48, -11.50 to -3.47) and small to moderate clinically better improvement in function (SMD -0.41, -0.67 to -0.15). In general, these results were similar for the intermediate and long term outcomes as were the effects of SMT as an adjuvant therapy. Evidence for sham SMT was low to very low quality; therefore these effects should be considered uncertain. Statistical heterogeneity could not be explained. About half of the studies examined adverse and serious adverse events, but in most of these it was unclear how and whether these events were registered systematically. Most of the observed adverse events were musculoskeletal related, transient in nature, and of mild to moderate severity. One study with a low risk of selection bias and powered to examine risk (n=183) found no increased risk of an adverse event (relative risk 1.24, 95% confidence interval 0.85 to 1.81) or duration of the event (1.13, 0.59 to 2.18) compared with sham SMT. In one study, the Data Safety Monitoring Board judged one serious adverse event to be possibly related to SMT. CONCLUSION: SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.


Assuntos
Doença Crônica/terapia , Dor Lombar/terapia , Manipulação da Coluna , Humanos , Dor Lombar/fisiopatologia , Manipulação da Coluna/efeitos adversos , Manipulação da Coluna/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Resultado do Tratamento
8.
Praxis (Bern 1994) ; 107(21): 1139-1146, 2018.
Artigo em Alemão | MEDLINE | ID: mdl-30326808

RESUMO

Acute Effects on TH4 Thoracic Spine Mobilisation Techniques on the Sympathetic Nervous System - a Cross-Over Feasibility Study Abstract. Up to date, empiric evidence about effects of thoracic spine mobilisation (TH4) on the sympathetic nervous system is lacking. The primary goal of this feasibility study was to determine adherence rate, side effects and the protocol as well as the implementation of the study design. The secondary goal was to analyse and interpret acute effects on the sympathetic nervous system after thoracic mobilisation in anterior thrust and posterior thrust on six healthy participants on two following days. The feasibility of this study was adequate. The spine mobilisations did not produce any adverse effects. The anterior thrust spine mobilisations showed a tendency in reducing the heart rate activity.


Assuntos
Manipulação da Coluna , Amplitude de Movimento Articular/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Vértebras Torácicas/fisiopatologia , Adulto , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Estudos de Viabilidade , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Manipulação da Coluna/efeitos adversos , Projetos Piloto , Adulto Jovem
9.
Trials ; 19(1): 306, 2018 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-29866131

RESUMO

BACKGROUND: Low back pain is a common and costly condition. Spinal manipulative therapy (SMT) is a treatment supported in some guidelines, although most clinical trials examining SMT report small effect sizes. Enhancing the effects of SMT requires an understanding of underlying mechanisms and a systematic approach to leverage understanding of mechanisms to create more effective treatment protocols that are scalable in clinical practice. Prior work has identified effects on spinal stiffness and lumbar multifidus activation as possible mechanisms. This project represents a refinement phase study within the context of a multi-phase optimization strategy (MOST) framework. Our goal is to identify an optimized SMT treatment protocol by examining the impact of using co-intervention exercise strategies that are proposed to accentuate SMT mechanisms. The optimized protocol can then be evaluated in confirmation phase clinical trials and implementation studies. METHODS: A phased, factorial randomized trial design will be used to evaluate the effects of three intervention components provided in eight combinations on mechanistic (spinal stiffness and multifidus muscle activation) and patient-reported outcomes (pain and disability). All participants will receive two sessions then will be randomly assigned to receive six additional sessions (or no additional treatment) over the next three weeks with factorial combinations of additional SMT and exercise co-interventions (spine mobilizing and multifidus activating). Outcome assessments occur at baseline, and one week, four weeks, and three months after enrollment. Pre-specified analyses will evaluate main effects for treatment components as well as interaction effects. DISCUSSION: Building on preliminary findings identifying possible mechanisms of effects for SMT, this trial represents the next phase in a multiphase strategy towards the ultimate goal of developing an optimized protocol for providing SMT to patients with LBP. If successful, the results of this trial can be tested in future clinical trials in an effort to produce larger treatment benefits and improve patient-centered outcomes for individuals with LBP. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02868034 . Registered on 16 August 2016.


Assuntos
Dor Lombar/terapia , Manipulação da Coluna/métodos , Coluna Vertebral/fisiopatologia , Adolescente , Adulto , Fenômenos Biomecânicos , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Masculino , Manipulação da Coluna/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Utah , Adulto Jovem
10.
Chiropr Man Therap ; 26: 11, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29713457

RESUMO

Background: Spinal manipulation (SM) has been shown to have an effect on pain perception. More knowledge is needed on this phenomenon and it would be relevant to study its effect in asymptomatic subjects. Objectives: To compare regional effect of SM on pressure pain threshold (PPT) vs. sham, inactive control, mobilisation, another SM, and some type of physical therapy. In addition, we reported the results for the three different spinal regions. Method: A systematic search of literature was done using PubMed, Embase and Cochrane. Search terms were ((spinal manipulation) AND (experimental pain)); ((spinal manipulative therapy OR spinal manipulation) AND ((experimental pain OR quantitative sensory testing OR pressure pain threshold OR pain threshold)) (Final search: June 13th 2017). The inclusion criteria were SM performed anywhere in the spine; the use of PPT, PPT tested in an asymptomatic region and on the same day as the SM. Studies had to be experimental with at least one external or internal control group. Studies on only spinal motion or tenderness, other reviews, case reports, and less than 15 invited participants in each group were excluded. Evidence tables were constructed with information relevant to each research question and by spinal region. Results were reported in relation to statistical significance and were interpreted taking into account their quality. Results: Only 12 articles of 946 were accepted. The quality of studies was generally good. In 8 sham controlled studies, a psychologically and physiologically "credible" sham was found in only 2 studies. A significant difference was noted between SM vs. Sham, and between SM and an inactive control. No significant difference in PPT was found between SM and another SM, mobilisation or some type of physical therapy. The cervical region more often obtained significant findings as compared to studies in the thoracic or lumbar regions. Conclusion: SM has an effect regionally on pressure pain threshold in asymptomatic subjects. The clinical significance of this must be quantified. More knowledge is needed in relation to the comparison of different spinal regions and different types of interventions.


Assuntos
Doenças Assintomáticas/terapia , Manipulação da Coluna , Limiar da Dor/fisiologia , Pressão/efeitos adversos , Análise de Variância , Fenômenos Biomecânicos , Humanos , Manipulação da Coluna/efeitos adversos , Manipulação da Coluna/métodos , Medição da Dor , Limiar da Dor/psicologia , Reprodutibilidade dos Testes
11.
Chiropr Man Therap ; 26: 14, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29760878

RESUMO

Background: Dizziness in older people is a risk factor for falls. Neck pain is associated with dizziness and responds favourably to neck manipulation. However, it is unknown if chiropractic intervention including instrument-assisted manipulation of the neck in older people with neck pain can also improve dizziness. Methods: This parallel two-arm pilot trial was conducted in Melbourne, Australia over nine months (October 2015 to June 2016). Participants aged 65-85 years, with self-reported chronic neck pain and dizziness, were recruited from the general public through advertisements in local community newspapers and via Facebook. Participants were randomised using a permuted block method to one of two groups: 1) Activator II™-instrument-assisted cervical and thoracic spine manipulation plus a combination of: light massage; mobilisation; range of motion exercises; and home advice about the application of heat, or 2) Sham-Activator II™-instrument-assisted manipulation (set to zero impulse) plus gentle touch of cervical and thoracic spinal regions. Participants were blinded to group allocation. The interventions were delivered weekly for four weeks. Assessments were conducted one week pre- and post-intervention. Clinical outcomes were assessed blindly and included: dizziness (dizziness handicap inventory [DHI]); neck pain (neck disability index [NDI]); self-reported concerns of falling; mood; physical function; and treatment satisfaction. Feasibility outcomes included recruitment rates, compliance with intervention and outcome assessment, study location, success of blinding, costs and harms. Results: Out of 162 enquiries, 24 participants were screened as eligible and randomised to either the chiropractic (n = 13) or sham (n = 11) intervention group. Compliance was satisfactory with only two participants lost to follow up; thus, post-intervention data for 12 chiropractic intervention and 10 sham intervention participants were analysed. Blinding was similar between groups. Mild harms of increased spinal pain or headaches were reported by 6 participants. Costs amounted to AUD$2635 per participant. The data showed a trend favouring the chiropractic group in terms of clinically-significant improvements in both NDI and DHI scores. Sample sizes of n = 150 or n = 222 for dizziness or neck pain disability as the primary outcome measure, respectively, would be needed for a fully powered trial. Conclusions: Recruitment of participants in this setting was difficult and expensive. However, a larger trial may be feasible at a specialised dizziness clinic within a rehabilitation setting. Compliance was acceptable and the outcome measures used were well accepted and responsive. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000653763. Registered 13 June 2013.Trial funding: Foundation for Chiropractic Research and Postgraduate Education (Denmark).


Assuntos
Acidentes por Quedas/prevenção & controle , Tontura/terapia , Manipulação Quiroprática/métodos , Manipulação da Coluna/métodos , Cervicalgia/terapia , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Tontura/complicações , Tontura/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Manipulação Quiroprática/efeitos adversos , Manipulação Quiroprática/instrumentação , Manipulação da Coluna/efeitos adversos , Manipulação da Coluna/instrumentação , Cervicalgia/complicações , Cervicalgia/fisiopatologia , Satisfação do Paciente , Projetos Piloto , Resultado do Tratamento
12.
J Otolaryngol Head Neck Surg ; 47(1): 25, 2018 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-29631624

RESUMO

BACKGROUND: This is the first case to our knowledge of a serious adverse event following the Epley maneuver, which is the treatment of choice for benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder in adults. CASE PRESENTATION: A 77 year old female presented for outpatient evaluation of vertigo at a tertiary otolaryngology clinic. She was found to have BPPV clinically, and elected to have a particle repositioning maneuver (Epley maneuver) performed in clinic. Immediately following Epley maneuver, she had severe nausea and vomiting, with evolving visual changes. A CT angiogram of the brain was performed urgently through the emergency department and demonstrated an acute intraparenchymal hemorrhage in the occipital lobe. After medical stabilization and rehabilitation, the patient continues to have a permanent visual field deficit. CONCLUSION: The Epley maneuver is safe and effective, and there are no prior reports of serious adverse events associated with its use. This case, in which a patient experienced a hemorrhagic stroke after undergoing the Epley maneuver, is the first and sole case in the medical literature of an Epley-associated serious adverse event. The indirect causation and extreme rarity of this event do not warrant any change to patterns of practice.


Assuntos
Vertigem Posicional Paroxística Benigna/terapia , Hemorragias Intracranianas/etiologia , Manipulação da Coluna/efeitos adversos , Posicionamento do Paciente/efeitos adversos , Acidente Vascular Cerebral/etiologia , Idoso , Feminino , Humanos
13.
Chiropr Man Therap ; 26: 9, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29541445

RESUMO

Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice. With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia. A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.


Assuntos
Anestesia Epidural/métodos , Dor nas Costas/terapia , Doença Crônica/terapia , Sedação Consciente/métodos , Manipulação da Coluna/métodos , Cervicalgia/terapia , Manejo da Dor/métodos , Anestesia Epidural/efeitos adversos , Dor nas Costas/fisiopatologia , Sedação Consciente/efeitos adversos , Tomada de Decisões , Humanos , Manipulação da Coluna/efeitos adversos , Cervicalgia/fisiopatologia , Medição da Dor , Resultado do Tratamento
14.
J Orthop Sports Phys Ther ; 48(3): 137-145, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29406835

RESUMO

Study Design Randomized clinical trial. Background The comparative effectiveness between nonthrust manipulation (NTM) and thrust manipulation (TM) for mechanical neck pain has been investigated, with inconsistent results. Objective To compare the clinical effectiveness of concordant cervical and thoracic NTM and TM for patients with mechanical neck pain. Methods The Neck Disability Index (NDI) was the primary outcome. Secondary outcomes included the Patient-Specific Functional Scale (PSFS), numeric pain-rating scale (NPRS), deep cervical flexion endurance (DCF), global rating of change (GROC), number of visits, and duration of care. The covariate was clinical equipoise for intervention. Outcomes were collected at baseline, visit 2, and discharge. Patients were randomly assigned to receive either NTM or TM directed at the cervical and thoracic spines. Techniques and dosages were selected pragmatically and applied to the most symptomatic level. Two-way mixed-model analyses of covariance were used to assess clinical outcomes at 3 time points. Analyses of covariance were used to assess between-group differences for the GROC, number of visits, and duration of care at discharge. Results One hundred three patients were included in the analyses (NTM, n = 55 and TM, n = 48). The between-group analyses revealed no differences in outcomes on the NDI (P = .67), PSFS (P = .26), NPRS (P = .25), DCF (P = .98), GROC (P = .77), number of visits (P = .21), and duration of care (P = .61) for patients with mechanical neck pain who received either NTM or TM. Conclusion NTM and TM produce equivalent outcomes for patients with mechanical neck pain. The trial was registered with ClinicalTrials.gov (NCT02619500). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2018;48(3):137-145. Epub 6 Feb 2018. doi:10.2519/jospt.2018.7738.


Assuntos
Manipulação da Coluna/métodos , Cervicalgia/terapia , Adulto , Vértebras Cervicais/fisiopatologia , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Masculino , Manipulação da Coluna/efeitos adversos , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Visita a Consultório Médico , Vértebras Torácicas/fisiopatologia , Fatores de Tempo
15.
World Neurosurg ; 112: 217-220, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29408299

RESUMO

BACKGROUND: Most people understand spinal manipulation therapy to be a safe procedure, and in many cases treatment is provided without a diagnosis if there is musculoskeletal pain. Cervical epidural hematoma occurs in extremely rare cases after cervical manipulation therapy. This study reports a case of epidural hematoma that occurred in the anterior spinal cord after cervical massage. CASE DESCRIPTION: A 38-year-old male patient was admitted to the emergency department for sudden weakness in the lower extremity after receiving a cervical spine massage. No fracture was found using cervical radiographs, and there were no particular findings on performing brain computed tomography or diffusion magnetic resonance imaging. However, using cervical magnetic resonance imaging, an acute epidural hematoma was observed in the anterior spinal cord from the C6 and C7 vertebrae to the T1 vertebra, compressing the spinal cord. There were no fractures or ligament injury. No surgical treatment was required as the patient showed spontaneous improvements in muscle strength and was discharged after just 1 week, following observation of the improvement in his symptoms. CONCLUSION: Although cervical epidural hematoma after cervical manipulation therapy is extremely rare, if suspected, a thorough examination must be performed in order to reduce the chances of serious neurologic sequelae.


Assuntos
Hematoma Epidural Espinal/complicações , Manipulação da Coluna/efeitos adversos , Massagem/efeitos adversos , Paraparesia/etiologia , Adulto , Hematoma Epidural Espinal/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Paraparesia/diagnóstico por imagem
16.
CJEM ; 20(2): 307-312, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28412987

RESUMO

Back pain is one of the most common presentations to the emergency department. Though case reports of patients presenting with increased back pain following chiropractic spinal manipulations are rare, we have identified a case rarely reported in the literature where a potential injury from chiropractic manipulation resulted in a diagnosis of multiple myeloma. We have reported a previously healthy 66-year-old male who presented with persistent lower back pain over 4 weeks. An initial evaluation with thoracolumbar radiographs revealed no significant findings. Following initial presentation to the family physician, the patient underwent three treatments of spinal manipulation from his local chiropractor, which resulted in worsening lower back pain. A re-examination and new radiographs in the hospital revealed multiple compression fractures and an underlying diagnosis of multiple myeloma. We have explored current literature examining the prevalence of lower back pain, as well as the incidence of spinal fracture following chiropractic manipulation, and have highlighted a potential complication from chiropractic manipulation in a patient with an undiagnosed underlying neoplastic disorder.


Assuntos
Dor nas Costas/etiologia , Serviço Hospitalar de Emergência , Fraturas por Compressão/complicações , Vértebras Lombares/lesões , Manipulação da Coluna/efeitos adversos , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões , Idoso , Dor nas Costas/diagnóstico , Diagnóstico Diferencial , Fraturas por Compressão/diagnóstico , Humanos , Doença Iatrogênica , Vértebras Lombares/diagnóstico por imagem , Masculino , Radiografia , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/diagnóstico por imagem
17.
Joint Bone Spine ; 85(2): 239-242, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28456600

RESUMO

OBJECTIVES: To examine beliefs about cracking sounds heard during high-velocity low-amplitude (HVLA) thrust spinal manipulation in individuals with and without personal experience of this technique. METHODS: We included 100 individuals. Among them, 60 had no history of spinal manipulation, including 40 who were asymptomatic with or without a past history of spinal pain and 20 who had nonspecific spinal pain. The remaining 40 patients had a history of spinal manipulation; among them, 20 were asymptomatic and 20 had spinal pain. Participants attended a one-on-one interview during which they completed a questionnaire about their history of spinal manipulation and their beliefs regarding sounds heard during spinal manipulation. RESULTS: Mean age was 43.5±15.4years. The sounds were ascribed to vertebral repositioning by 49% of participants and to friction between two vertebras by 23% of participants; only 9% of participants correctly ascribed the sound to the formation of a gas bubble in the joint. The sound was mistakenly considered to indicate successful spinal manipulation by 40% of participants. No differences in beliefs were found between the groups with and without a history of spinal manipulation. CONCLUSIONS: Certain beliefs have documented adverse effects. This study showed a high prevalence of unfounded beliefs regarding spinal manipulation. These beliefs deserve greater attention from healthcare providers, particularly those who practice spinal manipulation.


Assuntos
Cultura , Manipulação da Coluna/métodos , Som , Doenças da Coluna Vertebral/reabilitação , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Manipulação da Coluna/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor , Amostragem , Doenças da Coluna Vertebral/diagnóstico , Resultado do Tratamento
18.
Arch Phys Med Rehabil ; 99(1): 72-81, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28712922

RESUMO

OBJECTIVE: To describe the use of manipulative treatment for shoulder and spine conditions among various provider types. DESIGN: Retrospective observational cohort. SETTING: Single military hospital. PARTICIPANTS: Consecutive sample of patients (N=7566) seeking care for an initial spine or shoulder condition from January 1 to December 31, 2009. INTERVENTIONS: Manipulative treatment (eg, manual therapy, spinal and joint manipulation). MAIN OUTCOME MEASURE: Manipulation treatment was identified with procedure billing codes in the medical records. Spine and shoulder conditions were identified by using the International Classification of Diseases, 9th Revision codes. All data were abstracted from the Department of Defense Military Health System Management and Analysis Tool. RESULTS: Of 7566 total patients seeking care, 2014 (26.6%) received manipulative treatment at least once, and 1883 of those received this treatment in a military facility (24.7%). Manipulative treatment was used most often for thoracic conditions and least often for shoulder conditions (50.8% and 24.2% of all patients). There was a total of 6706 unique medical visits with a manipulative treatment procedure (average of 3.3 manipulative treatment procedure visits per patient). CONCLUSIONS: Manipulative treatment utilization rates for shoulder and spine conditions ranged from 26.6% to 50.2%. Chiropractors used manipulation the most and physical therapists the least.


Assuntos
Hospitais Militares/estatística & dados numéricos , Manipulação Quiroprática/estatística & dados numéricos , Manipulação da Coluna/estatística & dados numéricos , Doenças Musculoesqueléticas/terapia , Adulto , Vértebras Cervicais , Quiroprática/estatística & dados numéricos , Feminino , Humanos , Vértebras Lombares , Masculino , Manipulação Quiroprática/efeitos adversos , Manipulação da Coluna/efeitos adversos , Pessoa de Meia-Idade , Fisioterapia/estatística & dados numéricos , Médicos/estatística & dados numéricos , Estudos Retrospectivos , Ombro , Vértebras Torácicas , Estados Unidos
19.
Am J Phys Med Rehabil ; 97(4): e23-e26, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28796647

RESUMO

Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4-5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.


Assuntos
Síndrome da Cauda Equina/etiologia , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/patologia , Manipulação da Coluna/efeitos adversos , Massagem/efeitos adversos , Adulto , Dorso , Incontinência Fecal/etiologia , Humanos , Masculino , Manipulação da Coluna/métodos , Massagem/métodos , Incontinência Urinária/etiologia
20.
Musculoskelet Sci Pract ; 33: 41-45, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29153924

RESUMO

Manipulation and mobilisation of the cervical spine are well established interventions in the management of patients with headache and/or neck pain. However, their benefits are accompanied by potential, yet rare risks in terms of serious adverse events, including neurovascular insult to the brain. A recent international framework for risk assessment and management offers directions in the mitigation of this risk by facilitating sound clinical reasoning. The aim of this article is to critically reflect on and summarize the current knowledge about cervical spine manual therapy and to provide guidance for clinical reasoning for cervical spine manual therapy.


Assuntos
Vértebras Cervicais , Manipulação da Coluna/efeitos adversos , Cervicalgia/reabilitação , Segurança do Paciente , Feminino , Humanos , Masculino , Manipulação da Coluna/métodos , Cervicalgia/diagnóstico , Medição da Dor , Guias de Prática Clínica como Assunto , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
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