Bilateral simultaneous optic nerve dysfunction after periorbital trauma: recovery of vision in association with with chiropractic spinal manipulation therapy

OBJECTIVE: To discuss the recovery of optic nerve function after chiropractic spinal manipulation in a patient with loss of vision as a result of facial fracture from a fall. CLINICAL FEATURES: In a fall down a stairwell, a 53-year-old woman with migraines fractured her right zygomatic arch, which was later treated surgically. Approximately 3 weeks after the accident, vision in her contralateral eye became reduced to light perception. Electrophysiologic studies revealed that the function of both optic nerves was diminished, the right significantly more than the left. Single photon emission tomography showed pancerebral ischemic foci. INTERVENTION AND OUTCOME: Chiropractic spinal manipulation was used to aid recovery of vision to normal over a course of 20 treatment sessions. At times, significant improvement in vision occurred immediately after spinal manipulation. Progressive recovery of vision was monitored by serial visual field tests and by electrophysiologic studies. Unfortunately, the patient refused a further single photon emission tomographic study when visual recovery was complete. CONCLUSION: This case report adds to previous accounts of progressive and expeditious recovery of optic nerve function in association with spinal manipulation therapy.     

The types and frequencies of improved nonmuskuloskeletal symptoms reported after chiropractic spinal manipulative therapy

Objective: To investigate the frequency and types of improved nonmuskuloskeletal symptoms reported after chiropractic spinal manipulative therapy. Design: Retrospective information obtained by chiropractors through standardized interview of patients on return visit within 2 weeks of previous treatment. Setting: The private practice of 87 Swedish chiropractors (response rate 81%). Subjects: Twenty consecutive (presumably naïve) patients per chiropractor (1504 valid questionnaires returned, 86% of optimal number of replies). Intervention: Spinal manipulation with or without additional therapy provided by chiropractors. Main Outcome Measures: Self-reported improved nonmuskulo-skeletal symptoms (reactions). Results: At least 1 reaction was reported after the previous treatment in 21% to 25% of cases. Of these responses, 26% were related to the airway passages (usually reported as “easier to breathe”), 25% were related to the digestive system (mostly reported as “improved function”), 14% were classified under eyes/vision (usually reported as “improved vision”), and 14% under heart/circulation (about half of these reported as “improved circulation”). The number of spinal areas treated was positively associated with the number of reactions. Conclusion: A minority of chiropractic patients report having positive nonmuskuloskeletal reactions after spinal manipulative therapy but such reports cluster predominantly around specific symptoms. It would be interesting to find out if these can be verified objectively and, if so, to investigate if they are caused by the treatment or if they are signs of natural variations in human physiology. (J Manipulative Physiol Ther 1999; 22:559–64)     

Learning spinal manipulation: a comparison of two teaching models

Purpose:

The goal of the present study was to quantify the high-velocity, low-amplitude spinal manipulation biomechanical parameters in two cohorts of students from different teaching institutions. The first cohort of students was taught chiropractic techniques in a patient–doctor positioning practice setting, while the second cohort of students was taught in a “complete practice” manipulation setting, thus performing spinal manipulation skills on fellow student colleagues. It was hypothesized that the students exposed to complete practice would perform the standardized spinal manipulation with better biomechanical parameters.

Methods:

Participants (n = 88) were students enrolled in two distinct chiropractic programs. Thoracic spine manipulation skills were assessed using an instrumented manikin, which allowed the measurement of applied force. Dependent variables included peak force, time to peak force, rate of force production, peak force variability, and global coordination.

Results:

The results revealed that students exposed to complete practice demonstrated lower time to peak force values, higher peak force, and a steeper rate of force production compared with students in the patient–doctor positioning scenario. A significant group by gender interaction was also noted for the time to peak force and rate of force production variables.

Conclusion:

The results of the present study confirm the importance of chiropractic technique curriculum and perhaps gender in spinal manipulation skill learning. It also stresses the importance of integrating spinal manipulation skills practice early in training to maximize the number and the quality of significant learner–instructor interactions.     

The influence of a chiropractic manipulation on lumbar kinematics and electromyography during simple and complex tasks: a case study

OBJECTIVE: To investigate whether a more sophisticated and detailed analysis of both simple and complex tasks may yield more information regarding the short-term influence of an adjustment on spine biomechanics. METHODS: The study used a single-subject, before-after design. Three-dimensional spine kinematics and trunk muscle electromyography were assessed during a variety of tasks performed by a professional golfer exhibiting non-specific, chronic, low back pain. The patient received a right-to-left and left-to-right spinous pull adjustment. RESULTS: After the adjustment, changes were seen in all 3 axes of motion during a golf swing, with concomitant muscle responses. In addition, changes in the off axes of motion were seen during simple movement tasks. CONCLUSIONS: A more detailed spine kinematic analysis, specifically analysis of motion in the nonprincipled axes, yielded more information regarding the short-term influence of an adjustment on lumbar spine motion and muscle function.     

Neuromechanical characterization of in vivo lumbar spinal manipulation. Part II. Neurophysiological response

OBJECTIVE: To simultaneously quantify vertebral motions and neuromuscular and spinal nerve root responses to mechanical force, manually assisted, short-lever spinal manipulative thrusts. METHODS: Four patients underwent lumbar laminarthrectomy to decompress the central spinal canal and neuroforamina, as clinically indicated. Prior to decompression, finely threaded, 1.8-mm diameter intraosseous pins were rigidly fixed to the lumbar spinous process (L1 or L3) using fluoroscopic guidance, and a high-frequency, low-noise, 10-g, triaxial accelerometer was mounted to the pin. Following decompression, 4 needle electromyographic (nEMG) electrodes were inserted into the multifidus musculature adjacent to the pin mount bilaterally, and 2 bipolar platinum electrodes were cradled around the left and right S1 spinal nerve roots. With the spine exposed, spinal manipulative thrusts were delivered internally to the lumbosacral spinous processes and facet joints and externally by contacting the skin overlying the respective spinal landmarks using 2 force settings ( approximately 30 N, < 5 milliseconds (ms); approximately 150 N, < 5 ms) and 2 force vectors (posteroanterior and superior; posteroanterior and inferior). RESULTS: Spinal manipulative thrusts resulted in positive electromyographic (EMG) and compound action potential (CAP) responses that were typically characterized by a single voltage potential change lasting several milliseconds in duration. However, multiple EMG and CAP discharges were observed in numerous cases. The temporal relationship between the initiation of the mechanical thrust and the neurophysiologic response to internal and external spinal manipulative therapy (SMT) thrusts ranged from 2.4 to 18.1 ms and 2.4 to 28.6 ms for EMG and CAP responses, respectively. Neurophysiologic responses varied substantially between patients. CONCLUSIONS: Vertebral motions and resulting spinal nerve root and neuromuscular reflex responses appear to be temporally related to the applied force during SMT. These findings suggest that intersegmental motions produced by spinal manipulation may play a prominent role in eliciting physiologic responses.     

Upper cervical manipulation combined with mobilization for the treatment of atlantoaxial osteoarthritis: a report of 10 cases

Objective

This study presents the outcomes of patients with idiopathic degenerative and posttraumatic atlantoaxial osteoarthritis who were treated with upper cervical manipulation in combination with mobilization device therapy.

Clinical Features

A retrospective case review of 10 patients who were diagnosed with either degenerative or posttraumatic atlantoaxial arthritis based on histories, clinical symptoms, physical examination, and radiographic presentations was conducted at a multidisciplinary integrated clinic that used both chiropractic and orthopedic services. All 10 patients selected for this series were treated with a combination of upper cervical manipulation and mechanical mobilization device therapy. Outcome measures were collected at baseline and at the end of the treatment period. Assessments were measured using patients' self-report of pain using a numeric pain scale (NPS), physical examination, and radiologic changes. Average premanipulative NPS was 8.6 (range, 7-10), which was improved to a mean NPS of 2.6 (range, 0-7) at posttreatment follow-up. Mean rotation of C1-C2 at the end of treatment was improved from 28° (±3.1) to 52° (±4.5). Restoration of joint space was observed in 6 patients. Overall clinical improvement was described as “good” or “excellent” in about 80% of patients. Clinical improvements in pain and range of motion were seen in 80% and 90% of patients, respectively.

Conclusion

Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients.     

Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study

Purpose

The aim of this study was to determine the short-term effect of chiropractic joint manipulation therapy (CMT) and low-level laser therapy (LLLT) on pain and range of motion in the management of cervical facet dysfunction.

Methods

Sixty ambulatory women between the ages of 18 and 40 years with cervical facet joint pain of more than 30-day duration and normal neurologic examination were randomized to receive 1 of 3 treatment options: (1) CMT of the cervical spine, (2) LLLT applied to the cervical facet joints, or (3) a combination of CMT and LLLT. Each participant received 6 treatments in 3 weeks. The main outcome measures were as follows: the Numerical Pain Rating Scale, Neck Disability Index, Cervical Range of Motion Instrument, and Baseline Digital Inclinometer. Measurements were taken during weeks 1 (baseline), 2, 3, and 4.

Results

No differences existed between the 3 groups at baseline. A significant difference was seen between groups 1 (CMT) and 2 (LLLT) for cervical flexion, between groups 1 (CMT) and 3 (CMT + LLLT) for cervical flexion and rotation, and between groups 2 (LLLT) and 3 (CMT + LLLT) for pain disability in everyday life, lateral flexion, and rotation.

Conclusion

All 3 groups showed improvement in the primary and secondary outcomes. A combination of CMT and LLLT was more effective than either of the 2 on their own. Both therapies are indicated as potentially beneficial treatments for cervical facet dysfunction. Further studies are needed to explore optimal treatment procedures for CMT and LLLT and the possible mechanism of interaction between therapies.     

冯氏脊柱定点旋转复位法治疗外伤致青少年腰椎间盘突出症的效果观察与护理

目的探讨青少年腰椎间盘突出症的发病原因,观察手法治疗和针对性护理的有效性。方法选取2000--2007年本科室收治的120例外伤致腰椎间盘突出症患者为研究对象,采用冯氏脊柱定点旋转复位法进行治疗,同时对其采用针对性护理模式进行护理,后对结果进行观察研究。结果经治疗护理后,120例患者中痊愈106例,好转12例,无效2例,总有效率达到98．3％。结论采用冯氏脊柱定点旋转复位法结合针对性护理对于外伤致青少年腰椎间盘突出症效果较好,值得临床推广应用。     

电针刺激神经干对脑缺血再灌注后不同时期皮层BDNF mRNA表达的影响

目的　观察脑缺血再灌注大鼠脑源性神经营养因子 (BDNF)的动态变化过程及电针刺激神经干对BDNF表达的影响。方法　共选取成年健康雌性Wistar大鼠 68只 ,采用线栓法建立脑缺血再灌注动物模型 ,并随机分为对照组 (4只 )、MCAO组 (3 2只 )及神经干电针刺激组 (3 2只 )。神经干电针刺激组大鼠于再灌注后 2h ,6h ,12h ,2 4h ,2d ,3d ,7d及 14d时各进行 1次神经干电针刺激。利用原位杂交法观察上述时间点各组大鼠脑皮层BDNFmRNA表达的时程变化过程。结果　脑缺血 1h再灌注 2h ,6h ,12h ,2 4h ,2d及 3d时 ,MCAO组与对照组比较 ,前者缺血侧脑皮层BDNFmRNA阳性细胞数量显著增多 (均P <0 .0 1) ,并且于再灌 2h及再灌 2 4h时分别出现峰值 ,如再灌 2h时的BDNFmRNA含量显著高于再灌 6h及再灌 12h时的BDNFmR NA含量 ,而再灌 2 4h时的BDNFmRNA含量则显著高于其它各时间点的BDNFmRNA含量 (均P <0 .0 5 )。经电针刺激神经干后 ,大鼠在缺血再灌 2h以后的各时间点里 ,其缺血侧脑皮层BDNFmRNA阳性细胞数量均显著多于MCAO组及对照组 (均P <0 .0 5 )。结论　电针刺激缺血再灌注大鼠神经干 ,可显著增强其缺血侧脑皮质BDNFmRNA的表达 ,可能是电针刺激发挥脑保护效应的重要机制之一。     

Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial

Background

Manual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear.

Spinal epidural hematoma after spinal manipulation therapy: Report of three cases and a literature review

BACKGROUNDSpinal manipulation therapy (SMT) has been widely used worldwide to treat musculoskeletal diseases, but it can cause serious adverse events. Spinal epidural hematoma (SEH) caused by SMT is a rare emergency that can cause neurological dysfunction. We herein report three cases of SEH after SMT.CASE SUMMARYThe first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT. Her symptoms persisted after 3 d of conservative treatment, and she was admitted to our hospital. Magnetic resonance imaging (MRI) demonstrated an SEH, extending from C6 to C7. The second case was a 55-year-old man with sudden back pain 1 d after SMT, numbness in both lower limbs, an inability to stand or walk, and difficulty urinating. MRI revealed an SEH, extending from T1 to T3. The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT. He was unable to stand or walk and experienced mild back pain. MRI revealed an SEH, extending from T1 to T2. All three patients underwent surgery after failed conservative treatment. The three cases recovered to ASIA grade E on day 5, 1 wk, and day 10 after surgery, respectively. All patients returned to normal after 3 mo of follow-up.CONCLUSIONSEH caused by SMT is very rare, and the condition of each patient should be evaluated in full detail before operation. SEH should be diagnosed immediately and actively treated by surgery.     

原发性开角型青光眼前视路形态变化及与视网膜神经纤维层厚度的关系

目的 探讨原发性开角型青光眼(POAG)患者视束、视交叉的形态变化特征,分析其与视网膜神经纤维层厚度(RNFLT)的关系。 方法 对37例POAG患者(POAG组)行全脑磁共振T1加权三维磁化强度预备快速梯度回波序列扫描,利用多基线、多平面重建技术显示视束、视交叉结构,测量视束脑池段横径(TD1)及高径(H1)、视束大脑脚周段横径(TD2)及高径(H2)、视交叉横径(OC-TD)、高径(OC-H)及前后径(APD)。以1000名健康志愿者作为对照组。采用两样本t检验比较两组各径线测量值,采用Pearson检验对POAG组各径线与RNFLT进行相关性分析。 结果 ①POAG组双侧TD1、H1、TD2、H2均小于对照组(P均＜0.05)。②POAG组OC-TD、OC-H小于对照组(P均＜0.05),而两组APD差异无统计学意义(P＞0.05)。③POAG组双侧TD1之和、H1之和、TD2之和及H2之和均与双眼RNFLT之和呈正相关性(r＝0.77、0.77、0.81、0.77,P均＜0.05)。④POAG组OC-TD、OC-H与双眼RNFLT之和呈正相关(r＝0.44、0.60,P均＜0.05),而APD与双眼RNFLT之和无相关性(r＝0.10,P＞0.05)。 结论 POAG患者视束、视交叉萎缩与视网膜神经纤维缺损有关。     

Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: implications for the treatment of neuropathic pain and dysfunction

MethodsBilateral sciatic nerve sections were harvested from six cadavers. Matched pairs of nerve sections were secured in a tissue tester and injected with a plasma/Toluidine Blue dye solution. Once the initial dye spread stabilized, the experimental nerve sections underwent 25 stretch/relaxation cycles (e.g. simulated neural mobilization) produced by a mechanical tissue tester. Post-test dye spread measurements were compared to pre-test measurements as well as control findings (no simulated mobilization). Data were analyzed using paired t-tests.ResultsIndividual dye spread measurements were reliable [ICC(3,1) = 0·99]. The post-test intraneural fluid movement (dye spread) in the experimental section increased significantly with simulated neural mobilization compared to pre-test measurements (3·2±2·1 mm; P = 0·015) and control measurements (3·3±2·7 mm; P = 0·013).ConclusionRepetitive simulated neural mobilization, incorporating stretch/relax cycles, of excised cadaveric peripheral nerve tissue produced an increase in intraneural fluid dispersion. Neural mobilization may alter nerve tissue environment, promoting improved function and nerve health, by dispersing tissue fluid and diminishing intraneural swelling and/or pressure.     

Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: implications for the treatment of neuropathic pain and dysfunction

Abstract

Background and purpose:

Neural mobilization techniques are used clinically to treat neuropathic pain and dysfunction. While selected studies report efficacy of these techniques, the mechanisms of benefit are speculative. The purpose of this study was to evaluate the effects of in vitro simulated stretch/relax neural mobilization cycles on fluid dispersion within sections of unembalmed cadaveric peripheral nerve tissue.

Methods:

Bilateral sciatic nerve sections were harvested from six cadavers. Matched pairs of nerve sections were secured in a tissue tester and injected with a plasma/Toluidine Blue dye solution. Once the initial dye spread stabilized, the experimental nerve sections underwent 25 stretch/relaxation cycles (e.g. simulated neural mobilization) produced by a mechanical tissue tester. Post-test dye spread measurements were compared to pre-test measurements as well as control findings (no simulated mobilization). Data were analyzed using paired t-tests.

Results:

Individual dye spread measurements were reliable [ICC(3,1)?=?0·99]. The post-test intraneural fluid movement (dye spread) in the experimental section increased significantly with simulated neural mobilization compared to pre-test measurements (3·2±2·1 mm; P?=?0·015) and control measurements (3·3±2·7 mm; P?=?0·013).

Conclusion:

Repetitive simulated neural mobilization, incorporating stretch/relax cycles, of excised cadaveric peripheral nerve tissue produced an increase in intraneural fluid dispersion. Neural mobilization may alter nerve tissue environment, promoting improved function and nerve health, by dispersing tissue fluid and diminishing intraneural swelling and/or pressure.