Spinal epidural hematoma after spinal manipulation therapy:Report of three cases and a literature review

BACKGROUND Spinal manipulation therapy(SMT)has been widely used worldwide to treat musculoskeletal diseases,but it can cause serious adverse events.Spinal epidural hematoma(SEH)caused by SMT is a rare emergency that can cause neurological dysfunction.We herein report three cases of SEH after SMT.CASE SUMMARY The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT.Her symptoms persisted after 3 d of conservative treatment,and she was admitted to our hospital.Magnetic resonance imaging(MRI)demonstrated an SEH,extending from C6 to C7.The second case was a 55-year-old man with sudden back pain 1 d after SMT,numbness in both lower limbs,an inability to stand or walk,and difficulty urinating.MRI revealed an SEH,extending from T1 to T3.The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT.He was unable to stand or walk and experienced mild back pain.MRI revealed an SEH,extending from T1 to T2.All three patients underwent surgery after failed conservative treatment.The three cases recovered to ASIA grade E on day 5,1 wk,and day 10 after surgery,respectively.All patients returned to normal after 3 mo of follow-up.CONCLUSION SEH caused by SMT is very rare,and the condition of each patient should be evaluated in full detail before operation.SEH should be diagnosed immediately and actively treated by surgery.

Effects of biomechanical parameters of spinal manipulation: A critical literature review

Spinal manipulation is a manual treatment technique that delivers a thrust,using specific biomechanical parameters to exert its therapeutic effects.These parameters have been shown to have a unique dose-response relationship with the physiological responses of the therapy.So far,however,there has not been a unified approach to standardize these biomechanical characteristics.In fact,it is still undetermined how they affect the observed clinical outcomes of spinal manipulation.This study,therefore,reviewed the current body of literature to explore these dosage parameters and evaluate their significance,with respect to physiological and clinical outcomes.From the experimental studies reviewed herein,it is evident that the modulation of manipulation’s biomechanical parameters elicits transient physiological responses,including changes in neuronal activity,electromyographic responses,spinal stiffness,muscle spindle responses,paraspinal muscle activity,vertebral displacement,and segmental and intersegmental acceleration responses.However,to date,there have been few clinical trials that tested the therapeutic relevance of these changes.In addition,there were some inherent limitations in both human and animal models due to the use of mechanical devices to apply the thrust.Future studies evaluating the effects of varying biomechanical parameters of spinal manipulation should include clinicians to deliver the therapy in order to explore the true clinical significance of the dose-response relationship.

Analgesic Effects of Two Types of Spinal Manipulation in Acute Lumbar Radiculopathy Model Rats

Objective:To compare the analgesic effects of two types of spinal manipulation(SM)in acute lumbar radiculopathy(ALR)model rats induced by self-transplantation of autologous nucleus pulposus(ANP),and clarify the therapeutic mechanism.Methods:Totally 108 male Sprague-Dawley rats were randomly divided into 6 groups by a random number table(18 rats in each group),including a blank group with no interference,a sham operation group with a surgery by making a local soft tissue incision on the left side of L5-6 vertebral segment,a model group with ALR of L5 extraforaminal nerve by ANP self-transplantation without other interference,a sham manipulation(SMA)group with simulating physical rotation,as well as a mobilization(MOB)group with simulating low-velocity and variable-amplitudle rotation and a manipulation(MAN)group with simulating high-velocity and low-amplitude rotation.The interventions in SMA,MOB,and MAN groups started 1 day after modeling followed by another 5 treatments at days 3,5,8,10 and 12.Rats in the other3 groups did not receive any special intervention.Behavioral pain tests of 50%mechanical pain withdrawal threshold(50%PWT)and paw withdrawal latency(PWL)were conducted 1 day before operation followed by another 10 tests on days 1-7,10,12 and 14.Immunohistochemical expression of nitric oxide synthase(NOS)was investigated on days 5 and 12 after operation.Results:After 3 experimental SM interventions,50%PWT and PWL were higher in the MAN group than the SMA group on days 6 and 7,and higher on days 10,12 and14 postoperatively(P<0.05 or P<0.01),while the same indices were significantly higher in the MOB group than MAN group on days 1-4(P<0.05 or P<0.01).The expression of NOS was lower in the MAN and MOB groups than SMA group on day 12 postoperatively(P<0.01).Conclusions:Both manipulation and mobilization produced better results than sham interference in relieving pain by reducing neuroinflammation possibly.At the early period,compared with manipulation,mobilization presented less sensitive response to pain until later visit.SM may inhibit the overexpression of NOS,thereby alleviating severe radiculopathy.

Traditional Chinese spinal orthopedic manipulation

Traditional Chinese spinal orthopedic manipulation(TCSOM)is an external therapeutic method of traumatology and orthopedics of traditional Chinese medicine to treat trauma and set bone.The doctor exerts his force through thumb or bilateral upper extremities on the spine or acupoints of the patient,applying various manipulatory techniques according to the conditions.Correcting the abnormal position or state of the spine serve as the most important theoretical foundation for TCSOM to treat spinal disorders and spinogenic disorders.This paper presented the definition and function of the TCSOM,with a special focus on how to make a preliminary diagnosis of spinal segments disorders,and the indications of TCSOM in different spinal segments.

Manipulating extrinsic and intrinsic obstacles to axonal regeneration after spinal cord injury

Spinal cord injury（SCI）is a traumatic event that can lead to permanent motor and sensory deficits.After the initial trauma,axons of surviving neurons rapidly retract.While there may be a small degree of abortive sprouting,virtually all attempts at robust regrowth across the lesion site ultimately fail.Thus,neurons below the level of the injury are permanently disconnected from their normal input,resulting in persistent loss of function.

Retraction of lumbar disc herniation achieved by noninvasive techniques: A case report

BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneous laser disc decompression.Unfortunately,all of these methods carry inherent risk of causing harm to the patient and,as such,there is an unmet but urgent need for an effective and safe noninvasive treatment for LDH.The purpose of this report is to describe a non-invasive method for re-absorption of LDH.CASE SUMMARY A 34-year-old woman was admitted with a complaint of waist pain that she reported as having become acutely aggravated over the past 3 d and accompanied by discomfort in the right lower limb.Her self-reported medical history included persistent postpartum low back pain from 7 years prior.Physical exam showed positivity for neck flexion test(Lindner sign)and supine abdomen test;the straight leg-raising test showed right 60(+)and left 80(-).Findings from standard imaging(magnetic resonance)and collective physical examinations indicated a L5/S1 herniated lumbar disc.Treatment consisted of three-dimensional(balanced regulating)spinal manipulation and acupuncture,upon which the LDH resolved by retraction.CONCLUSION Following L5/S1 herniated lumbar disc diagnosis,three-dimensional(balanced regulating)spinal manipulation combined with acupuncture therapy is an effective treatment.

A Clinical Observation of Functional Abdominal Pain Syndrome in Patients Treated by Traditional Chinese Spinal Orthopedic Manipulation

Objective： To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation（TCSOM） in treating patients with functional abdominal pain syndrome（FAPS） in comparison with Pinaverium Bromide（Dicetel, PBD）, and to assess a possible cause for FAPS. Methods： Eighty patients with FAPS were randomly and equally assigned to the TCSOM group and PBD group according to the random number table. All patients in the TCSOM group were treated with a maximum of 5 times of spinal manipulations. Patients in the PBD group were instructed to take 50 mg 3 times a day, consistently for 2 weeks. The symptoms of pre-and post-treatment were assessed on a visual analog scale（VAS） pain score. A symptom improvement rating（SIR） was implemented to evaluate the effects of the treatments. Results： The symptoms of 27 cases of the TCSOM group were relieved soon after the first TCSOM treatment and 9 cases were significantly improved. The VAS pain scores in the TCSOM group were significantly lower than those in the PBD group after 2 weeks treatment. According to the SIR based on VAS, the TCSOM group included 30 cases with excellent results, 7 cases with good, and 3 cases with poor. Adverse events to the treatment were not reported. Based on VAS, the PBD group reported 8 cases with excellent results, 10 cases with good and 22 cases with poor. There was a significant difference between the two groups（P〈0.01）. Conclusions： The displacement of intervertebral discs and/or vertebra in the thoracic or lumbar region seems to be a contributing factor in the symptoms of FAPS. TCSOM is an effective treatment for FAPS.

Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae

OBJECTIVE: To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation(TCSOM) in treating chondromalacia patellae(CP).METHODS: Sixty cases of CP patients were randomly assigned to a TCSOM group and a Celecoxib group according to the random number table method. All patients in the TCSOM group were treated with a maximum of 10 spinal manipulations and rehabilitation training of quadriceps femoris. The symptoms before and after treatment were assessed with visual analog scale(VAS) and Kujala functional knee scoring system(KFKSS). A symptom improvement rate(SIR) was implemented in order to evaluate the effects of the treatments.RESULTS: The symptoms of 16 patients in the TC-SOM group quickly resolved after the first spinal manipulation and 8 cases were significantly improved. The VAS scores in the TCSOM group after 4weeks of treatment were significantly lower than those in the Celecoxib group. The KFKSS scores in the TCSOM group after 4 weeks of treatment were significantly higher than those in the Celecoxib group. Side effects of the treatment were not reported. Symptom improvement rate based on the VAS in the TCSOM group indicated more significant improvements than the Celecoxib group.CONCLUSION: TCSOM has greater efficacy than Celecoxib capsules for relief of the symptoms of CP.

CLINICAL STUDY ON MANIPULATIVE TREATMENT OF DERANGEMENT OF THE ATLANTOAXIAL JOINT

The derangement of the atlantoaxial joint is one of main cervical sources of dizziness and headache, which were based on the observation on the anatomy of the upper cervical vertebrae, analysis of X-ray film of the atlantoaxial joint, and the manipulative treatment in 35 patients with cervical spondylosis. The clinical diagnosis of derangement consists of: dizziness, headache, prominence and tenderness on one side of the affected vertebra, deviation of the dens for 1 mm-4 mm on the open-mouth X-ray film, abnormal movement of the atlantoaxial joint on head-rotated open-mouth X-ray film. An accurate and delicate adjustment is the most effective treatment.

Clinical effects of innovative tuina manipulations on treating cervical spondylosis of vertebral artery type and changes in cerebral blood flow

OBJECTIVE:To determine the clinical effect,treatment times,and rheoencephalogram changes in vertebral artery type cervical spondylosis patients treated with innovative Tuina manipulations.METHODS:One hundred and twenty six cervical spondylosis patients(vertebral artery type) were randomly divided into test and control groups.Patients in the test group were treated with innovative Tuina manipulations,while those in the control group were treated with the routine Tuina manipulations according to the textbook of Chinese Massage for Acupuncture and Moxibustion majors.The clinical effects,treatment times,clinical symptoms,and cerebral blood flow were measured.RESULTS:The response to the treatment was 100% in the test group and 88.71% in the control group.Patients in the test group required(7 ± 4) treatments before recovery,while those in the control group required(15 ± 7) treatments before recovery(P<0.05).The clinical symptoms exhibited greater improvement in the test group compared to the control group(P<0.05).There were no differences in cerebral blood flow between the two groups.CONCLUSION:Both innovative Tuina manipulations and routine Tuina manipulations produced satisfactory therapeutic results in vertebral artery type cervical spondylosis patients.However,the innovative manipulation was more effective in improving the functional symptoms,although there were no changes in the cerebral blood flow.

Clinical observation on acupuncture at Jiaji(EX-B 2) points plus tuina in treating thoracic facet joint disorder

Objective： To observe the clinical effects of acupuncture at Jiaji （EX-B 2） points plus tuina manipulation for thoracic facet joint disorder, and get new clinical evidence for treatment of thoracic facet joint disorder. Methods： Totally 106 patients with thoracic facet joint disorder were randomly allocated into an observation group and a control group based on the random number table. Patients in the control group were treated by tuina manipulation, while those in the observation group were treated by acupuncture at Jiaji （EX-B 2） points before tuina manipulation. Patients in the two groups were treated once a day. The improvements of signs and symptoms and the efficacy were observed after 3 treatments. Results： After treatment, there were intra-group statistical differences in scores of 8 signs and symptoms in both groups （P〈0.01}; the score of each item in the observation group was lower than that in the control group, and there was statistical significance in the inter-group difference （P〈0.05）. The cure rate of the observation group was 50.9%, versus 26.4% in the control group, and there was a significant difference between the two groups （P〈0.05）. Conclusion： In treating thoracic facet joint disorder, acupuncture plus tuina manipulation can restore the biomechanical balance of thoracic vertebrae, fully maximized the combined effect, and significantly improve the clinical efficacy.

Subtle adjustment of the cervical spine combined with Shu Jing Ding Xuan Decoction for cervical vertigo

Objective：To observe the effect of subtle adjustment of the cervical spine combined with Shu Jing Ding Xuan （Neck-relaxing and Dizziness-alleviating） Decoction for cervical vertigo. 〈br〉 Methods：An open-label, randomized and parallel controlled clinical study was designed. Subtle adjustment of the cervical spine combined with Shu Jing Ding Xuan （Neck-relaxing and Dizziness-alleviating） Decoction was used for patients in the treatment group, whereas subtle adjustment alone was used for patients in the control group. The results in the two groups were statistically analyzed after two courses of treatment. 〈br〉 Results：The recovery rate and total effective rate in the treatment group were 20.6%and 88.2%respectively, versus 14.7%and 73.5%in the control group. The inter-group differences were statistically significant （both P＆lt;0.01）. 〈br〉 Conclusion： Subtle adjustment of the cervical spine combined with Shu Jing Ding Xuan （Neck-relaxing and Dizziness-alleviating） Decoction is better than subtle adjustment alone for cervical vertigo.