THE BACK PAgE REsEARCH REVIEW spinal manipulative therapy for neck, arm pain reviewed by shawn thistle 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. pubLiCAtion inFormAtion: Journal of Manipulative & Physiological Therapeutics 2013; 36: 461-467. S tatistically, 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 combi-nation 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 modifica-tions, pain medications, physical ther-apy, epidural injections and, sometimes, spinal manipulative therapy (SMT). The purpose of this study was to in-vestigate the clinical outcomes in pa-tients suffering from cervical radiculop-athy after a course of care utilizing high-velocity, low-amplitude (HVLA) SMT. 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 chiroprac-tor 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. 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 re-ported clinically relevant improvement, with none of these patients reporting they were worse. The acute patients reported statisti-cally 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. Pertinent results Study methods On first visit, patients completed ques-tionnaires detailing demographic infor-mation, a baseline numeric rating scale (NRS) for pain and the neck pain dis-ability index (NDI). At two weeks, one month and two months after the initial consultation, a research assistant con-tacted the patients by phone and the NDI and NRS were repeated. Addi-tionally, the patients’ own (perceived) global impressions of change (PGIC) were collected, where the patient rated their condition as much worse, slightly 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 im-proved. At this point, no one reported worsening of their symptoms. At one month after the first treatment, 68.9 per cent of individuals were signifi-cantly 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 signif-icant improvement. Most of the patients in this study re-ported clinically significant improve-ment at all selected data points, espe-cially at three months. The fact that even the subacute/ chronic sufferers showed clinically significant improvement is an impor-tant result to report, as it is these pa-tients who are often the most costly to the health-care system. This is an important study that adds to the results of prior systematic re-views on this topic. The authors of this study demon-strated 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. For more on this review, visit www. canadianchiropractor.ca. www.canadianchiropractor.ca Conclusions and practical application 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. 38 Canadian Chiropractor February 2014
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