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Research Review Corner: February 2014


February 11, 2014
By Shawn Thistle


Topics

Statistically, 83.2 out of every 100,000 people suffer from symptomatic compression of a cervical nerve root caused by a disc herniation (CDH), degenerative spondylosis, or a combination of the two, with the C6 and C7 nerve roots being most commonly involved. 

Study title: Outcomes from magnetic resonance imaging-confirmed symptomatic cervical disk herniation patients treated with high-velocity, low-amplitude spinal manipulative therapy: A prospective cohort study with three-month follow-up

Authors: Peterson CK, Schmid C, Leemann S, et al.

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Publication information: Journal of Manipulative & Physiological Therapeutics 2013; 36: 461-467.

Statistically, 83.2 out of every 100,000 people suffer from symptomatic compression of a cervical nerve root caused by a disc herniation (CDH), degenerative spondylosis, or a combination of the two, with the C6 and C7 nerve roots being most commonly involved. 

Patients suffering from symptoms of cervical radiculopathy are often treated with lifestyle changes, activity modifications, pain medications, physical therapy, epidural injections and, sometimes, spinal manipulative therapy (SMT).

The purpose of this study was to investigate the clinical outcomes in patients suffering from cervical radiculopathy after a course of care utilizing high-velocity, low-amplitude (HVLA) SMT.

Study methods
On first visit, patients completed questionnaires detailing demographic information, a baseline numeric rating scale (NRS) for pain and the neck pain disability index (NDI). At two weeks, one month and two months after the initial consultation, a research assistant contacted the patients by phone and the NDI and NRS were repeated. Additionally, the patients’ own (perceived) global impressions of change (PGIC) were collected, where the patient rated their condition as much worse, slightly worse, no change, slightly better, better and much better. 

A standard treatment procedure of a single, HVLA cervical manipulation with rotation to the opposite side and lateral flexion to the same side of the affected arm was performed. The goal was to move the affected segment and produce an audible release (cavitation). The presence or absence of release was not recorded, as it was not achieved in all cases. In the case where an audible release was not achieved, the chiropractor performed the manipulation up to two additional times. Treatments were performed three to five times a week for the first two to four weeks, and then one to three times a week thereafter, until the patient was asymptomatic.

Pertinent results
Fifty patients were enrolled in the study – 68 per cent were male and the average age was ~44. Two weeks after the first treatment, 55.3 per cent of all patients reported they had significantly improved. At this point, no one reported worsening of their symptoms. At one month after the first treatment, 68.9 per cent of individuals were significantly improved, with only one patient reporting being slightly worse (one patient in the subacute/chronic group). By three months, this figure rose to 85.7 per cent of patients noting significant improvement.

In general, acute patients reported faster improvement compared to those who were included in the subacute or chronic group. However, three months after the first treatment, 76.2 per cent of the subacute/chronic patients reported clinically relevant improvement, with none of these patients reporting they were worse.

The acute patients reported statistically significant reductions in their neck and arm pain measured via NRS, as well as their NDI scores at all three data points.

The subacute/chronic patients had similar results, with the exception of the baseline-two-week data point, where their NRS arm score was not significantly reduced.

Conclusions and practical application
Most of the patients in this study reported clinically significant improvement at all selected data points, especially at three months.

The fact that even the subacute/chronic sufferers showed clinically significant improvement is an important result to report, as it is these patients who are often the most costly to the health-care system.

This is an important study that adds to the results of prior systematic reviews on this topic.

 The authors of this study demonstrated that patients with symptomatic, MRI-confirmed CDH can be treated with SMT at the level of herniation, as most patients in this study reported high levels of clinically relevant improvement at all measured data points.


Dr. SHAWN THISTLE is the founder and president of Research Review Service, a subscription-based service to helping practitioners integrate current, relevant, scientific evidence into their practice (www.researchreviewservice.com ). This article was submitted by Dr. Demetry Assimakopoulos.


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