High-Velocity Low-Amplitude Spinal Manipulation for Symptomatic Lumbar Disk Disease: A Systematic Review of the Literature
Received 26 July 2004
Objective
The aim of the study was to review the evidence for high-velocity low-amplitude spinal manipulation (HVLASM) for symptomatic lumbar disk disease (SLDD).
Methods
A systematic review of the literature was performed. The Cochrane Central Register of Controlled Trials, Medline, Cumulative Index to Nursing and Allied Health Literature, and Mantis were searched. Evidence-based operational definitions of SLDD, HVLASM, and outcomes measures were established. Articles were assessed using these inclusion criteria: (1) published in English, (2) measured at least one outcome in subjects with SLDD undergoing HVLASM, (3) descriptions were sufficiently clear to meet all 3 categories of our operational definitions. Articles that met the inclusion criteria were assessed by 2 independent reviewers and assigned quality ratings based on previously published guidelines.
Results
Sixteen studies met the inclusion criteria, representing 203 total subjects. Of these, 172 subjects received HVLASM as active treatment, and 31 received other treatments as comparison subjects. Improvements in patient-based and physiological outcomes were reported among subjects receiving HVLASM; however, no conclusions regarding safety and effectiveness could be drawn from this review because the overall body of evidence uncovered was lacking in quality and quantity.
Conclusion
HVLASM for SLDD has been reasonably described in the literature; however, the evidence is limited, and definitive conclusions on safety and effectiveness cannot be made at this time. The reviewed evidence supports the hypothesis that HVLASM may be effective in the treatment of SLDD and does not support the hypothesis that HVLASM is inherently unsafe in SLDD cases. It appears that patients with lumbar disk pathology do undergo manipulative treatment in practice. Consequently, this should be an area of research importance. More high-quality clinical trials using valid and reliable diagnostic criteria and outcomes measures are needed.
aStaff Chiropractor, Veterans Affairs Connecticut Healthcare System, West Haven, Conn (since October 2004); Associate Professor, University of Bridgeport College of Chiropractic, Bridgeport, Conn; Associate Faculty, Palmer Center for Chiropractic Research, Davenport, Iowa
bPrivate practice of chiropractic, Vancouver, British Columbia, Canada
cResearch Associate, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Canada; PhD Student, Institute for Work and Health, Toronto, Ontario, Canada
Submit requests for reprints to: Anthony J. Lisi, DC, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516
Sources of support: No external funding was received for this study.
ABSTRACT