Manipulation Under Anesthesia

A Conservative Treatment Alternative For Patients With Chronic Pain

Spinal manipulation under anesthesia is a procedure that primarily originated with the osteopathic profession and has been utilized for the treatment of spinal pain since the late 1930s. Documentation regarding the success and value of manipulation under anesthesia has been recorded in the osteopathic literature since 1948 when Clybourne reported in the Journal of American Osteopath Association a success rate of 80-90% which has been maintained to this day.

In the last two decades, the emphasis regarding manipulation in osteopathic education has greatly decreased. Therefore, the osteopaths that had been adequately trained in manipulation are coming to the close of their careers or have retired. Because of the need for continuance of this procedure, the focus for the performance of spinal manipulation under anesthesia has now shifted to chiropractors and their expertise in spinal manipulation skills.

Indication For Manipulation Under Anesthesia

Spinal manipulation under anesthesia is a procedure that is intended for patients that suffer from sometimes acute, but mostly chronic musculoskeletal disorders in conjunction with biomechanical aberrancies. These individuals have also been unresponsive to previous conservative therapy. Etiology of their pain can be disc bulge/herniation, chronic sprain/strain, failed back surgery, myofacial pain syndromes in conjunction with those listed below. The procedure is extremely beneficial for the patient that has muscle spasm accompanied with pain and terminal joint range of motion loss. These types of patients typically respond well to manipulation/physical therapy/exercise, but their relief may only be temporary (days to weeks). To ensure good results with a procedure of this type, one of the most important considerations is patient selection. 
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  1. Bulging, protruded, prolapsed or herniated discs without free fragment and are not surgical candidates
  2. Frozen or fixated articulations
  3. Failed low back surgery
  4. Compression syndromes with or without radiculopathies caused from adhesion formation, but not associated with osteophyic entrapment
  5. Restricted motion, which causes pain and apprehension from the patient
  6. Unresponsive to manipulation and adjustment when they are the therapy of choice
  7. Unresponsive pain, which interferes with the function of daily life and sleep patterns, but which falls within the parameters for manipulative treatment
  8. Unresponsive muscle contraction, which is preventing normal daily activities and function
  9. Post-traumatic syndrome injuries from acceleration/deceleration or deceleration/acceleration types of injuries, which result in painful exacerbation of chronic fixations
  10. Chronic recurrent neuromusculoskeletal dysfunction syndromes, which result in a regular periodic treatment series, that are always exacerbation of the same condition
  11. Neuromusculoskeletal conditions that are not surgical candidates but have reached MMI especially with occupational injuries

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