Characteristics of lumbar disc herniation with exacerbation of presentation due to spinal manipulative therapy

Sheng-Li Huang, Yan-Xi Liu, Guo-Lian Yuan, Ji Zhang, Hong-Wei Yan, Sheng-Li Huang, Yan-Xi Liu, Guo-Lian Yuan, Ji Zhang, Hong-Wei Yan

Abstract

The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4-15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4-L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging.

Conflict of interest statement

The authors have no funding, financial relationships, or conflicts of interest.

Figures

FIGURE 1
FIGURE 1
MRI showing the location of the disc fragments. (A, B) Cephalic type. (C, D) Ventral type. (E, F) Caudal type. (A, C, E) T1-weighted images. (B, D, F) T2-weighted images.

References

    1. Saal JA, Saal JS, Herzog RJ. The natural history of lumbar intervertebral disc extrusions treated nonoperatively. Spine (Phila Pa 1976) 1990; 15:683–686.
    1. Bush K, Cowan N, Katz DE, et al. The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine (Phila Pa 1976) 1992; 17:1205–1212.
    1. Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther 2004; 27:197–210.
    1. Tamburrelli FC, Genitiempo M, Logroscino CA. Cauda equina syndrome and spine manipulation: case report and review of the literature. Eur Spine J 2011; 20 Suppl 1:S128–S131.
    1. Dan NG, Saccasan PA. Serious complications of lumbar spinal manipulation. Med J Aust 1983; 2:672–673.
    1. Shvartzman P, Abelson A. Complications of chiropractic treatment for back pain. Postgrad Med 1988; 83:57–61.
    1. Huang SL, He XJ, Xiang L, et al. CT and MRI features of patients with diastematomyelia. Spinal Cord 2014; 52:689–692.
    1. Huang SL, He XJ, Lan BS. Surgical technique of diastematomyelia. Neurosurg Quart. Published online.
    1. Huang SL, He XJ, Wang KZ, et al. Diastematomyelia: a 35-year experience. Spine (Phila Pa 1976) 2013; 38:E344–E349.
    1. Huang SL, Jiang HX, Cheng B, et al. Characteristics and management of occult intrasacral extradural cyst in children. Br J Neurosurg 2013; 27:509–512.
    1. Huang SL, Shi W, Zhang LG. Congenital dermal sinus of the cervical spine: clinical characteristics and management. J Neurosurg Sci 2012; 56:61–66.
    1. Huang SL, Shi W, Zhang LG. Characteristics and surgery of cervical myelomeningocele. Childs Nerv Syst 2010; 26:87–91.
    1. Huang SL, Shi W, Zhang LG. Surgical treatment for lipomyelomeningocele in children. World J Pediatr 2010; 6:361–365.
    1. Huang SL, Yan HW, Wang KZ. Use of Fidji cervical cage in the treatment of cervical spinal cord injury without radiographic abnormality. BioMed Res Int 2013; 2013:810172.
    1. Assendelft WJ, Bouter LM, Knipschild PG. Complications of spinal manipulation: a comprehensive review of the literature. J Fam Pract 1996; 42:475–480.
    1. Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther 2004; 27:197–210.
    1. Haldeman S, Rubinstein SM. Cauda equina syndrome in patients undergoing manipulation of the lumbar spine. Spine (Phila Pa 1976) 1992; 17:1469–1473.
    1. Gerke DA, Brismée JM, Sizer PS, et al. Change in spine height measurements following sustained mid-range and end-range flexion of the lumbar spine. Appl Ergon 2011; 42:331–336.
    1. Owens SC, Brismée JM, Pennell PN, et al. Changes in spinal height following sustained lumbar flexion and extension postures: a clinical measure of intervertebral disc hydration using stadiometry. J Manipulative Physiol Ther 2009; 32:358–363.
    1. Lisi AJ, O’Neill CW, Lindsey DP, Zucherman JF, et al. Measurement of in vivo lumbar intervertebral disc pressure during spinal manipulation: a feasibility study. J Appl Biomech 2006; 22:234–239.
    1. Krismer M, Haid C, Rabl W. The contribution of anulus fibers to torque resistance. Spine (Phila Pa 1976) 1996; 21:2551–2557.
    1. Ahn UM, Ahn NU, Buchowski JM, et al. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine (Phila Pa 1976) 2000; 25:1515–1522.
    1. Delamarter RB, Sherman JE, Carr JB. 1991 Volvo Award in experimental studies. Cauda equina syndrome: neurologic recovery following immediate, early, or late decompression. Spine (Phila Pa 1976) 1991; 16:1022–1029.
    1. Rydevik BL, Nordborg C. Changes in nerve function and nerve fibre structure induced by acute graded compression. J Neurol Neurosurg Psychiatry 1980; 43:1070–1082.
    1. Rydevik BL, Pedowitz RA, Hargens AR, et al. Effects of acute, graded compression on spinal nerve root function and structure. An experimental study of the pig cauda equina. Spine (Phila Pa 1976) 1991; 16:487–493.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren