Manipulation of the Low Back Under General Anesthesia
Davis CG, DC. Fernando CA, MD. Do Motta MA, DC. Manipulation of the Low Back Under General Anesthesia: Case Studies and Discussion. J of Neuromusculoskeletal System. Fall 1993;1(3):126-134.
“Following this course of treatments, there was marked improvement in pain, with improvement in the orthopedic and neurologic exam. Medication use was decreased and functional capacity increased.” Page 126
“Failed back surgery syndrome is a common indication for MUA.” Page 126
“MUA was presented to the patient as an option for attempting to improve pain control and functioning. The procedure resulted in marked symptomatic improvement immediately after the MUA. Additionally, functional ability improved in these patients for whom physicians had expressed little hope of recovery of normal function.” Page 129
“The cross-links bind collagen fibers so that movement is restricted. When subjected to a high-velocity thrust, these cross-links may be disrupted without a resultant inflammatory reaction that would occur if the collagen fibers were torn.” Page 132
“The two patients in this case report had prolonged symptoms, and each had a number of back surgeries with radiographically identified postoperative scarring.” Page 132
“The MUA procedure in these cases have had longer lasting results than previous surgeries, nerve blocks, or medications.” Page 132
“Reports of manipulation under anesthesia have gone back as far as 1930 when
Riches reported successful treatment of 87 percent of his patients with chronic sciatica, and 92 percent with chronic sacroiliac strain with manipulation under anesthesia.” Page 132.
Many of the techniques require at least two operators, since control of the weight of the patient’s body and of the extremities rest entirely with the operators when the patient is under general anesthesia. This is particularly important with treatment directed at the lumbar spine and pelvis.” Page 133
“The assistant operator is needed for the positioning and stabilization of the patient and to assist in manipulations.” Page 133
“Care must be taken not to manipulate too vigorously under anesthesia. Instead of trying to achieve full range of motion in one manipulation, it is often better to manipulate more gently on two or more occasions.” Page 133
“Mennell has stated that it is no more irrational to use anesthesia to provide relaxation and to avoid pain in joint manipulation than it is to use anesthesia for the reduction of fractures and dislocation or extracting a tooth.” Page 133
“Both patients also regarded their functional capacity as being much improved.” Page 133
“With patients who have undergone surgery only to have the pain return due to scar tissue and fibrosis, MUA may be beneficial.” Page 134