PATIENT
EVALUATION
Candidates
are selected for manipulation under anesthesia after obtaining an
adequate history, thorough physical examination, and the appropriate
diagnostic imaging and laboratory procedures necessary for an
accurate diagnosis of the underlying condition.
History
and Physical
The
burden of proof for medical necessity rests with the treating doctor.
It should be substantially documented in the patient’s history
and physical, with specific emphasis on: the failure to respond to
conservative means in the history; indication of fibrosis and/or
myofibrosis in the physical examination; and any supportive
diagnostic testing as indicated and warranted by medical necessity of
the patient’s condition.
A
complete physical examination is performed paying special attention
to motion palpation of the spine and a visual inspection and
palpation of the skin (manifestation of sympathetic nervous system
changes including edema, tissue texture, increase or decrease of
moisture, temperature changes, etc). Additionally, digital palpation
identifies increased or decreased changes in muscle and fascia tone
which lead to altered biomechanics.
Laboratory
Exam
Laboratory
examinations should be performed to further evaluate patient health.
They not only contribute to differential diagnosis, but they also
help the medical saff assess patient health prior to going under
anesthesia. Females of child bearing years should be evaluated for
pregnancy.
Females
of child bearing years should be evaluated for pregnancy. A male past
40 years of age should also have the following test done: serum
alkaline and acid phosphatase. After completion of the preliminary
work, other laboratory procedures may be indicated.
Radiographic
Examination
Anterior-posterior
(front/back) and lateral (side) radiographs of the joints involved
should be taken. Additionally, extension and lateral bending views
may be of benefit in visualizing loss of function. Many times one may
want a detailed view of the joints which are to be manipulated under
anesthesia. Motion studies on fluoroscopy may be helpful.
Studies
should be repeated after serial manipulation under anesthesia to see
what changes have been affected by the procedure. When warranted, CT
Scan and/or MRI scan of the spine should be employed to rule out or
confirm suspected pathology.
Electrodiagnostic
Tests
Electrodiagnostic
studies of the appropriate spinal outflows should be performed to
rule out specific neurological dysfunction. These tests confirm or
differentiate diagnosis of neuropathy, radiculopathy or plexopathy.
They show the presence or lack of nerve compression and localize and
assess the degree of injury along the course of a nerve.
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.
