Comparison of outcomes in MRI confirmed lumbar disc herniation patients with and without modic changes treated with high velocity, low amplitude spinal manipulation
| Autor: | B. Kim Humphreys, Michelé Annen, Serafin Leemann, Cynthia K. Peterson, Bernard Anklin, Christof Schmid |
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| Přispěvatelé: | University of Zurich, Peterson, Cynthia |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Manipulation Spinal medicine.medical_specialty High velocity 610 Medicine & health Spinal manipulation Magnetic Resonance Imaging Interventional 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Pain Management Prospective Studies Pain Measurement 030222 orthopedics Lumbar Vertebrae business.industry Significant difference Leg pain Modic changes Middle Aged Surgery Biomechanical Phenomena Treatment Outcome 3602 Chiropractics Lumbar spine Female 10046 Balgrist University Hospital Swiss Spinal Cord Injury Center Chiropractics Lumbar disc herniation Manual therapy business Low Back Pain 030217 neurology & neurosurgery Intervertebral Disc Displacement Follow-Up Studies |
| Popis: | Objective The purpose of this study was to determine if there is a difference in outcomes between Modic positive and negative lumbar disc herniation (LDH) patients treated with spinal manipulative therapy (SMT). Methods This prospective outcomes study includes 72 MRI confirmed symptomatic LDH patients treated with SMT. Numerical rating scale (NRS) pain and Oswestry disability data were collected at baseline. NRS, patient global impression of change to assess overall improvement, and Oswestry data were collected at 2 weeks, 1, 3, 6 months and 1 year. MRI scans were analyzed for Modic change present/absent and classified as Modic I or II when present. Chi-squared test compared the proportion of patients reporting relevant 'improvement' between patients with and without Modic changes and those with Modic I vs. II. NRS and Oswestry scores were compared at baseline and change scores at all follow-up time points using the unpaired Student t test. Results 76.5% of Modic positive patients reported ‘improvement’ compared to 53.3% of Modic negative patients ( P = .09) at 2 weeks. Modic positive patients had larger decreases in leg pain ( P = .02) and disability scores ( P = .012) at 2 weeks. Modic positive patients had larger reductions in disability levels at 3 ( P = .049) and 6 months ( P = .001). A significant difference ( P = .001) between patients with Modic I vs. Modic II was found at 1 year, where Modic II patients did significantly better. Conclusion Modic positive patients reported higher levels of clinically relevant improvement 2 weeks, 3 and 6 months compared to Modic negative patients. However, at 1 year Modic I patients were significantly less likely to report ‘improvement’, suggesting they may be prone to relapse. |
| Databáze: | OpenAIRE |
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