Which
patients should be considered for manipulation under anesthesia?
Certain
neck, mid back, low back or other spinal conditions respond poorly to
conventional care. One proposed theory for this is that, as a result
of past or present injury, adhesions and scar tissue have built up
around spinal joints and within the surrounding muscles and causes
chronic pain.
Patients
often undergo various treatments, such as physical therapy,
chiropractic care, epidural injections, back surgery, or other
treatments that do not address fibrous adhesions. Some patients feel
temporarily better with these treatments, but their pain often
returns.
In
general, patients selected for manipulation under anesthesia are
those who have received conservative care for six to eight weeks. If
limited or no improvements in symptoms or objective findings have
occurred, then manipulation under anesthesia may be an appropriate
alternative.
Prior
to treatment, protocols of diagnostic testing should document the
nature of the diagnosis, support the need for treatment and eliminate
questions of psychosocial factors that can influence pain responses.
In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram
or nerve conduction velocity test may be ordered.
Supporting
Studies/Great Results
There
are several research studies about the effectiveness of manipulation
under anesthesia, including:
1.
83% of 600 patients with EMG verified radiculopathies reported
significant improvement - Robert Mensor, MD
2.
Patients that had back pain for a minimum of 10 years reported an
87% recovery rate after MUA - 1987 with Ongly et al
3.
51% of patients with unrelieved symptoms after conservative care
had been exhausted reported good to excellent results three years
post MUA - Donald Chrisman, MD
4.
71% of 723 MUA patients had good results (return to normal
activity relatively symptom free) and 25.3% had fair results (return
to normal activity with slight residuals) and that flexibility,
elasticity and range of motion can be restored following MUA -
Bradford and Siehl
5.
83% of 517 patients treated with MUA responded well - Paul Kuo,
MD professor of Orthopedic Surgery
6.
Krumhansi and Nowacek reported on an MUA study done on 171
patients who experienced constant intractable pain for several months
to 18 years. All of the patients of the study failed other
conservative intervention. The results of the study showed that 25%
of the patients had no pain, 50% were much improved with pain
markedly decreased, 20% were better and could tolerate their pain but
it interfered with work and recreation. Failures comprised 5% where
there was minimal or no pain relief periods.
