Abstract
Objective
To describe the safety and potential therapeutic benefit of spinal manipulation postepidural
injection in the nonsurgical treatment of patients with cervical and lumbar radiculopathy.
Methods
The study design was a retrospective review of outcomes of 20 cervical and 60 lumbar
radiculopathy patients who underwent spinal manipulation postepidural injection in
a hospital setting. Patients received either fluoroscopically guided or computed tomography
(CT)–guided epidural injection of a combination of lidocaine and Depo-Medrol. The
manual therapy consisted of an immediate postepidural application of flexion distraction
mobilization and then high-velocity, low-amplitude spinal manipulation to the affected
spinal regions. Outcome criteria were empirically defined as significant improvement,
temporary improvement, or no change. The minimum follow-up time for all patients was
1 year.
Results
There were no complications associated with spinal manipulation, whereas 3 complications
associated with the epidural injection procedure were noted. Of lumbar spine patients,
36.67% (n = 22) noted significant improvement, 41.67% (n = 25) experienced temporary
improvement, and 21.67% (n = 13) reported no change. Of the patients undergoing spinal
manipulation after cervical epidural injection, 50% (n = 10) noted significant improvement,
30% (n = 6) experienced temporary improvement, whereas 20% (n = 4) exhibited no change.
Conclusions
These data suggest that spinal manipulation postepidural injection is a safe nonsurgical
procedure to use in the treatment of the patient with radiculopathy of spinal origin.
This is also the first report of the use of spinal manipulation postepidural injection
in the cervical spine.
Key Indexing Terms
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Manipulative & Physiological TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation.J Bone Joint Surg Am. 1990; 72: 1178-1184
- The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study.J Bone Joint Surg Am. 2001; 83: 1306-1311
- MRI of cervical intervertebral discs in asymptomatic subjects.J Bone Joint Surg Br. 1998; 80: 19-24
- Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation.Spine. 1998; 23: 1252-1258
- Differentiating lumbar disc protrusions, disc bulges, and discs with normal contour but abnormal signal intensity. Magnetic resonance imaging with discographic correlations.Spine. 1999; 24: 44-53
- The clinical significance of the high-intensity zone on lumbar spine magnetic resonance imaging.Spine. 1999; 24: 1913-1919
- Extradural inflammation associated with annular tears: demonstration with gadolinium-enhanced lumbar spine MRI.Eur Spine J. 1999; 8: 34-39
- A controlled biochemical and immunohistochemical study of human synovial-type (group II) phospholipase A2 and inflammatory cells in macroscopically normal, degenerated, and herniated human lumbar disc tissues.Spine. 1996; 21: 2531-2538
- Pain and the nerve root. An interdisciplinary approach.Spine. 1993; 18: 2053-2058
Lundborg G. Structure and function of the intraneural microvessals as related to trauma, edema, formation, and nerve function. Annual Meeting American Society of Surgery Hand March 8-11, 1975. Englewood, CO: American Society of Surgery of Hand.
- The vascular pattern of the human dorsal root ganglion and its probable bearing on a compartment syndrome.Spine. 2002; 27: 347-352
- The role of inflammation in lumbar pain.Spine. 1995; 20: 1821-1827
- The effects of mechanical compression and hypoxia on nerve root and dorsal root ganglia. An analysis of ectopic firing using an in vitro model.Spine. 1996; 21: 2089-2094
- The role of mechanical deformation in lumbar radiculopathy: an in vivo model.Spine. 2002; 27: 27-33
- Primary afferents and inflammatory hyperexcitability.Pain. 1996; 67: 1-2
- Injury to dorsal root ganglia alters innervation of spinal cord dorsal horn lamina involved in nociception.Spine. 2000; 25: 537-542
- Epidural steroid injections for low back pain and lumbosacral radiculopathy.Pain. 1986; 24: 277-295
- Multiple control of inflammation by glucocorticoids.Agents Actions. 1986; 17: 284-289
- Injection therapy for subacute and chronic benign low back pain.Spine. 2001; 26: 501-515
- Conservative treatment of sciatica: a systematic review.J Spinal Disord. 2000; 13: 463-469
- Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases.AJNR Am J Neuroradiol. 1999; 20: 697-705
- Effects of side-posture positioning and side-posture adjusting on the lumbar zygapophysial joints as evaluated by magnetic resonance imaging: a before and after study with randomization.J Manipulative Physiol Ther. 2000; 23: 380-394
- First prize: central motor excitability changes after spinal manipulation: a transcranial magnetic stimulation study.J Manipulative Physiol Ther. 2002; 25: 1-9
- Spinal reflex attenuation associated with spinal manipulation.Spine. 2000; 24: 2519-2525
- Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil).J Manipulative Physiol Ther. 2001; 24: 552-555
- Spinal manipulation for low-back pain.Ann Intern Med. 1992; 117: 590-598
- Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions.Spine. 1997; 22: 2128-2156
- Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials.Pain. 1995; 63: 279-288
- Manipulation and mobilization of the cervical spine. A systematic review of the literature.Spine. 1996; 21: 1746-1759
- Treatment of cervical radiculopathy with flexion distraction.J Manipulative Physiol Ther. 2001; 24: 206-209
- Chiropractic management and manipulative therapy for MRI documented cervical disk herniation.J Manipulative Physiol Ther. 1994; 17: 177-185
- 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; 19: 597-606
- Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial.J Manipulative Physiol Ther. 1996; 19: 570-582
- A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.Spine. 2001; 26: 788-797
- Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain.Spine. 2002; 27: 2383-2389
- Medication-assisted spinal manipulation.Spine. 2002; 2: 288-302
- Low back pain: mechanism, diagnois and treatment. 6th ed. Williams & Wilkins, Baltimore1999: 261-272
- Principles of clinical myology: diagnosis and classification of muscle diseases–general considerations.in: Adams AH Victor M Ropper AH Principles of neurology. McGraw-Hill, New York1997: 1386-1401
- Chiropractic management of a patient with lumbar spinal stenosis.J Manipulative Physiol Ther. 2001; 24: 300-304
- The mechanical, neuromuscular, physiological effects produced by spinal manipulation.in: Herzog W Clinical biomechanics of spinal manipulation. Churchill Livingstone, New York2000: 191-207
- The prospective, randomized, controlled clinical trial in spine surgery: fact or fiction?.Spine. 1999; 24: 2550-2552
- Lumbar disc herniation. A controlled, prospective study with ten years of observation.Spine. 1983; 8: 131-140
- Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients.J Spinal Disord. 1999; 12: 396-401
- Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review.Spine. 1999; 24: 591-597
- Low back pain: which is the best way forward?.BMJ. 1999; 318: 1122-1123
- Local corticosteroid application blocks transmission in normal nociceptive C-fibres.Acta Anaesthesiol Scand. 1990; 34: 335-338
- Chiropractic: a profession at the crossroads of mainstream and alternative medicine.Ann Intern Med. 2002; 136: 216-227
- Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation.Eur Spine J. 2000; 9: 202-207
- Side posture manipulation for lumbar intervertebral disk herniation.J Manipulative Physiol Ther. 1993; 16: 96-103
- Rotary manipulation for cervical radiculopathy: observations on the importance of the direction of the thrust.J Manipulative Physiol Ther. 1997; 20: 622-627
- In vivo changes in the neuroforaminal size at flexion-extension and axial rotation of the cervical spine in healthy persons examined using kinematic magnetic resonance imaging.Spine. 2001; 26: E287-E293
- Kinematics of the cervical spine canal: changes with sagittal plane loads.J Spinal Disord. 1994; 7: 93-101
- Anatomic changes of the spinal canal and intervertebral foramen associated with flexion-extension movement.Spine. 1996; 21: 2412-2420
- Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study.Neurol Res. 1998; 20: 186-190
- Effects of vertebral axial decompression on intradiscal pressure.J Neurosurg. 1994; 81: 350-353
- Manipulation under epidural anesthesia with corticosteroid injection: two case reports.J Manipulative Physiol Ther. 1997; 20: 618-621
- Manipulation under anesthesia combined with epidural steroid injection.J Manipulative Physiol Ther. 1994; 17: 605-609
- Manual therapy with steroid injections–a new approach to treatment of low back pain. A controlled multicenter trial with an evaluation by orthopedic surgeons.Spine. 1994; 19: 569-577
- The use of epidural steroid injection and manipulation on patients with chronic low back pain.J Manipulative Physiol Ther. 1997; 20: 263-266
- Chronic lumbosciatic syndrome treated by epidural injection and manipulation.Practitioner. 1972; 209: 53-59
- Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs.Acta Orthop Scand. 1977; 48: 635-641
- Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus.N Engl J Med. 1997; 336: 1634-1640
Article info
Publication history
Received in revised form:
March 28,
2003
Received:
March 17,
2003
Identification
Copyright
© 2004 National Univesity of Helath Sciences. Published by Elsevier Inc. All rights reserved.
