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PubMed1982

The role of specific manipulation towards alleviating abnormalities in body mechanics and restoration of spinal motion.

This article presents a theoretical model based on previously published chiropractic theories and clinical experience. The thesis proposes a comparison of specific dynamically diagnosed manipulative procedure with non-specific statically determined mobilization. The proposed mechanism also theoretically provides a means by which one can determine areas of segmental motion-disturbance necessitating specific correction, as well as identifying areas where adjusting might be contraindicated. Theoretical considerations based on the model are then used to predict consequences of such procedures on hypermobility, fixation, correction efficacy, and side effects. Since the predictions can be tested experimentally, the model provides a basis for researching chiropractic theories and clinical options.

Cervical Vertebrae↗
PubMed2005

Cervical artery dissection. A comparison of highly dynamic mechanisms: manipulation versus motor vehicle collision.

OBJECTIVE: To examine the similarities and dissimilarities between cervical chiropractic manipulative therapy and whiplash, and their respective relation to cervical artery dissection. DATA SOURCES: A literature synthesis used MEDLINE-PubMed and MANTIS literature searches. A total list of 99 relevant articles was generated. Additional references were collected from citations incorporated within the included articles. RESULTS: Both neck manipulation and motor vehicle collision events apply loads to the spinal column rapidly. While neck manipulation loads are slower to develop and displacements smaller, they may reach peak amplitudes on maximum effort comparable to those seen in low-velocity collision experiments. In contrast to reports that the vertebral artery experiences elongations exceeding its physiological range by up to 9.0 mm during simulated whiplash, strains incurred during cervical manipulative therapy have been reported to be approximately one ninth of those required for mechanical failure, comparable to forces encountered in the course of diagnostic range of motion examination. Additionally, long-lasting abnormalities of blood flow velocity within the vertebral artery have been reported in patients following common whiplash injuries, whereas no significant changes in vertebral artery peak flow velocity were observed following cervical chiropractic manipulative therapy. CONCLUSIONS: Perceived causation of reported cases of cervical artery dissection is more frequently attributed to chiropractic manipulative therapy procedures than to motor vehicle collision related injuries, even though the comparative biomechanical evidence makes such causation unlikely. The direct evidence suggests that the healthy vertebral artery is not at risk from properly performed chiropractic manipulative procedures.

Accidents, Traffic↗
PubMed2006

Growth factor treatment and genetic manipulation stimulate neurogenesis and oligodendrogenesis by endogenous neural progenitors in the injured adult spinal cord.

Neurons and oligodendrocytes are highly vulnerable to various insults, and their spontaneous replacement occurs to only a limited extent after damage in the adult spinal cord. The environment of injured tissue is thus thought to restrict the regenerative capacity of endogenous neural stem/progenitor cells; strategies for overcoming such restrictions remain to be developed. Here, we combined growth factor treatment and genetic manipulation to stimulate neurogenesis and oligodendrogenesis by endogenous progenitors in vivo. The recombinant retrovirus pMXIG, which was designed to coexpress green fluorescent proteins (GFPs) and a neurogenic/gliogenic transcription factor, was directly injected into the injured spinal cord parenchyma to manipulate proliferative cells in situ. We found that cells expressing Olig2, Nkx2.2, and NG2 were enriched among virus-infected, GFP-positive (GFP+) cells. Moreover, a fraction of GFP+ cells formed neurospheres and differentiated into neurons, astrocytes, and oligodendrocytes in vitro, demonstrating that GFP retroviruses indeed infected endogenous neural progenitors in vivo. Neuronal differentiation of control virus-infected cells did not occur at a detectable level in the injured spinal cord. We found, however, that direct administration of fibroblast growth factor 2 and epidermal growth factor into lesioned tissue could induce a significant fraction of GFP-labeled cells to express immature neuronal markers. Moreover, retrovirus-mediated overexpression of the basic helix-loop-helix transcription factors Neurogenin2 and Mash1, together with growth factor treatment, enhanced the production and maturation of new neurons and oligodendrocytes, respectively. These results demonstrate that endogenous neural progenitors can be manipulated to replace neurons and oligodendrocytes lost to insults in the injured spinal cord.

Animals↗
PubMed1993

Osteopathy--an aid to the healing process.

1. Osteopaths deal primarily with the dysfunction of joints and the resulting effects. 2. Osteopaths believe that the body is able to heal itself and that their role is to aid this process. 3. Spinal dysfunction has wide-ranging effects on all bodily systems. 4. Osteopaths use a wide variety of techniques, not just supposedly painful manipulations, and treat both spinal and non-spinal problems.

Humans↗
PubMed1996

Cervical epidural hematoma after chiropractic manipulation in a healthy young woman: case report.

OBJECTIVE AND IMPORTANCE: Posttraumatic spinal epidural hematoma is an uncommon entity. We present the first report of spinal epidural hematoma occurring after chiropractic manipulation in a healthy young adult without preexisting cervical disease or any obvious predisposing factors. CLINICAL PRESENTATION: The patient presented with radicular and myelopathic symptoms that developed 15 minutes after chiropractic manipulation. Computed tomography and magnetic resonance imaging were performed. They revealed a cervical epidural hematoma. INTERVENTION: The hematoma was evacuated, and all of the patient's neurological symptoms improved over the course of the next 3 days. CONCLUSION: Although cervical spinal epidural hematoma is a rare clinical entity, it must be considered in patients with pain or neurological deficit after cervical trauma.

Adult↗
PubMed1992

An experimental model for peripheral neuropathy produced by segmental spinal nerve ligation in the rat.

We attempted to develop an experimental animal model for peripheral neuropathic pain. Under sodium pentobarbital anesthesia, both the L5 and L6 spinal nerves (group 1) or the L5 spinal nerve alone (group 2) of one side of the rat were tightly ligated. For comparison, a parallel study was conducted with another group of rats (group 3) which received a partial tight sciatic nerve ligation, a paradigm developed previously as a neuropathy model. Withdrawal latencies to application of radiant heat to the foot were tested for the next 16 weeks in all 3 groups. Sensitivity of the hind paw to mechanical stimulation was tested with von Frey filaments. The general behavior of each rat was noted during the entire test period. Results suggested that the surgical procedure in all 3 groups produced a long-lasting hyperalgesia to noxious heat (at least 5 weeks) and mechanical allodynia (at least 10 weeks) of the affected foot. In addition, there were behavioral signs of the presence of spontaneous pain in the affected foot. Therefore, we believe we have developed an experimental animal model for peripheral neuropathy using tight ligations of spinal nerves. The model manifests the symptoms of human patients with causalgia and is compatible with a previously developed neuropathy model. The present model has two unique features. First, the surgical procedure is stereotyped. Second, the levels of injured and intact spinal segments are completely separated, allowing independent experimental manipulations of the injured and intact spinal segments in future experiments to answer questions regarding mechanisms underlying causalgia.

Animals↗
PubMed1993

Effect of cervical spinal adjustments on lumbar paraspinal muscle tone: evidence for facilitation of intersegmental tonic neck reflexes.

OBJECTIVES: To determine whether spinal adjustments, delivered to the upper vs. lower cervical spine, might result in tonic neck reflex-induced alterations in the activity of the lumbar paraspinal musculature. DESIGN: Randomized, double-blind, before/after treatment comparisons. SETTING: Cervical Ergonomics Laboratory, Palmer College of Chiropractic-West, Sunnyvale, CA. SUBJECTS: Healthy, nonsymptomatic chiropractic college students, about evenly divided with respect to gender and ranging from 23-38 yr of age. INTERVENTION: Modified "diversified" spinal adjustments, delivered bilaterally to either the upper (C2) or lower (C7) cervical region. MAIN OUTCOME MEASURE: Tissue compliance measures using a tissue compliance meter, obtained from each subject at sites 2 cm on either side of the spinous processes of L1, L2, L3, L4 and L5 both prior to and within 15 min following treatments. RESULTS: Upper cervical adjustments produced changes in lumbar tissue compliance which were only slight (p < .05) and not significantly different from that which occurred following upper cervical sham manipulation (p > .1). However, lower cervical adjustments induced increases in tissue compliance (decreases in tone) which were highly significant (p < .001) and relatively robust compared to those found following upper cervical adjustments (p < .01). Furthermore, the greatest effects were observed on either side of the L4 and L5 spinous processes, suggesting influences on the gluteal musculature in particular. CONCLUSIONS: Results indicate that cervical spinal manipulation can have significant effects on the tone of the lumbopelvic musculature, presumably by facilitating tonic neck reflexes involving intersegmental spinal pathways.

Adult↗
PubMed2006

H wave and spinal root potentials in neuromonitoring of S1 root function during evacuation of herniated disc: preliminary results.

AIM: To determine the changes in the tibial H reflex and spinal nerve root potentials (SRPs) of the S1 root during posterior discectomy and the effects of surgical manipulation. METHODS: Tibial H reflex responses (M and H waves) were intermittently recorded from the soleus muscle by surface electrodes during different stages of surgery in 5 patients with S1 radiculopathy. All patients had Achilles reflex preserved bilateraly and no paresis on manual strength testing preoperatively. SRPs were additionally obtained by direct epidural recordings from the surgically exposed S1 root in 2 of them. RESULTS: The variations in the amplitude of H wave were minor and reversible upon the cessation of surgical manipulation of the root, but the H reflex was not lost either temporarily or permanently in any of the patients. Prolongation of H wave latency by up to 18% at the end of surgery in comparison with preoperative value was noticed in 4 patients. However, there was increased degree of desynchronization of the SRP in some phases of the spinal root manipulation, such as root mobilization before the disc incision and retraction during the disc evacuation. H waves and SRPs were continuously present during the surgery. Ankle jerks were preserved postoperatively in all 5 patients. CONCLUSION: Unremarkable variations in H wave latency may be followed by increased SRP desynchronization. Monitoring of the epidurally recorded SRPs seems to be more sensitive to surgical manipulations of the spinal nerve root than the tibial H reflex recordings from the soleus muscle.

Adult↗
PubMed2007

A biomechanical analysis of the self-retaining pedicle hook device in posterior spinal fixation.

Regular hooks lack initial fixation to the spine during spinal deformity surgery. This runs the risk of posterior hook dislodgement during manipulation and correction of the spinal deformity, that may lead to loss of correction, hook migration, and post-operative junctional kyphosis. To prevent hook dislodgement during surgery, a self-retaining pedicle hook device (SPHD) is available that is made up of two counter-positioned hooks forming a monoblock posterior claw device. The initial segmental posterior fixation strength of a SPHD, however, is unknown. A biomechanical pull-out study of posterior segmental spinal fixation in a cadaver vertebral model was designed to investigate the axial pull-out strength for a SPHD, and compared to the pull-out strength of a pedicle screw. Ten porcine lumbar vertebral bodies were instrumented in pairs with two different instrumentation constructs after measuring the bone mineral density of each individual vertebra. The instrumentation constructs were extracted employing a material testing system using axial forces. The maximum pull-out forces were recorded at the time of the construct failure. Failure of the SPHD appeared in rotation and lateral displacement, without fracturing of the posterior structures. The average pull-out strength of the SPHD was 236 N versus 1,047 N in the pedicle screws (P < 0.001). The pull-out strength of the pedicle screws showed greater correlation with the BMC compared to the SPHD (P < 0.005). The SPHD showed to provide a significant inferior segmental fixation to the posterior spine in comparison to pedicle screw fixation. Despite the beneficial characteristics of the monoblock claw construct in a SPHD, that decreases the risk of posterior hook dislodgement during surgery compared to regular hooks, the SPHD does not improve the pull-out strength in such a way that it may provide a biomechanically solid alternative to pedicle screw fixation in the posterior spine.

Animals↗
PubMed1992

Studies on the biomechanical effect of a spinal adjustment.

Manual treatment of spinal disorders is perhaps the most well-studied remedy for spine-related disorders. Clinical description and controlled studies provide only limited advances in knowledge because so little is known scientifically about manual treatment methods or the disorders to which they are directed. The common factor for all manual methods is that they apply an external load to the spine and its surrounding tissues. Merging of efforts by basic scientists, engineers and clinician-scientists can resolve some of the underlying scientific ambiguity surrounding these issues. This report reviews the seminal efforts in biomechanics that are emerging to describe and understand the treatment, the spinal disorder for which it is used and the physiological effects of the treatment.

Biomechanical Phenomena↗
PubMedDate not supplied

Toxicity of new spinal agents.

The clinical success of perispinal administration of opiates for pain relief has demonstrated the power of manipulating the neurochemistry of the spinal cord. This article briefly discussed reasons for increased interest in new spinal agents and some of the issues associated with determining their clinical safety.

Analgesics, Opioid↗
PubMed1996

Effect of proximal arterial perfusion pressure on function, spinal cord blood flow, and histopathologic changes after increasing intervals of aortic occlusion in the rat.

BACKGROUND AND PURPOSE: Cross-clamping of the thoracic aorta results in spinal cord ischemia and prominent systemic hypertension. Using a rat model of transient spinal cord ischemia. we examined the effects of manipulation of proximal aortic blood pressure on spinal cord blood flow (SCBF), neurological dysfunction, and changes in spinal histopathology after increasing intervals of aortic occlusion. METHODS: Aortic occlusion was induced by the inflation of a 2F Fogarty catheter placed into the thoracic aorta in rats anesthetized with halothane (1.5%). A tail artery was cannulated to monitor distal arterial pressure (DAP). To measure SCBF, a laser probe was implanted into the epidural space of the L-2 vertebra. To manipulate proximal arterial pressure (PAP), the left carotid artery was cannulated with a 20-gauge polytetrafluoroethylene catheter to permit blood withdrawal and infusion from a peripheral reservoir during aortic occlusion. In a survey study, spinal cord ischemia was induced in single animals at intervals of 6, 10, 15, 30, or 40 minutes with PAP controlled at 40, 60, 80, and 110 to 120 mm Hg. In a second series, ischemia was induced in groups of animals for 0, 6, 8, 10, and 12 minutes with PAP controlled at 40 mm Hg. After ischemia the animals survived for 2 to 3 days. During this recovery period, neurological functions were evaluated, followed by quantitative histopathology of the spinal cord. RESULTS: Under normal conditions, cross-clamping yields an acute proximal hypertension (125 to 135 mm Hg), a fall of DAP to 15 to 22 mm Hg, and a decrease in SCBF to 7% to 11% of baseline values. With the use of the external reservoir, proximal hypertension could be abolished and the PAP maintained at target pressures. In these studies a typical syndrome of tactile allodynia, spastic paraplegia, and necrotic changes affecting the central part of the gray matter after 24 to 48 hours of reperfusion was observed at the following combinations of ischemic intervals and PAP values: > 10 minutes/40 mm Hg; > 12 minutes/60 mm Hg; > 16 minutes/80 mm Hg; and > 30 minutes/uncontrolled. Lowering PAP resulted in a corresponding decrease in residual SCBF. Systematic studies at a PAP of 40 mm Hg at occlusion intervals of 6, 8, 10, and 12 minutes revealed that 100% of rats were paraplegic after 10- and 12-minute ischemia, and these rats showed corresponding signs of spinal histopathology. CONCLUSIONS: The present study shows that systemic intraischemic hypotension (40 mm Hg) significantly potentiates neurological dysfunction after transient aortic occlusion. The mechanism of the observed effect may include elimination of collateral flow during aortic occlusion and/or consequent potentiation of hypoperfusion during reperfusion. These data indicate that PAP during occlusion should be monitored and/or controlled because it is a critical variable in the determination of outcome in this model of spinal cord ischemia.

Animals↗
PubMed1975

Stability of the cervical spine after conservative treatment.

175 patients with cervical spine and spinal cord injuries were admitted to the Spinal Injuries Unit, Austin Hospital, in the five-year period from the 1 July 1968, to the 30 June 1973. Only 4-2 per cent of the patients required delayed spinal fusion for instability after a conservative treatment regime.

Adult↗
PubMed1996

Extradural and subarachnoid catheterization using the Seldinger technique.

The Seldinger technique was developed using a plastic introducer through which introduction and manipulations of a silicone spinal catheter, an extradural stimulation lead or a small diameter fibreoptic scope are possible without the risk of damage to the vulnerable devices. It is not intended as a replacement of the standard technique of introducing a spinal catheter through a Tuohy needle in general anaesthetic practice. Silicone spinal catheters and stimulation leads are used for long-term therapy in intractable chronic pain and spasticity. A fibreoptic scope is used for endoscopic examination of the subarachnoid or extradural space. Using a standard Tuohy needle the soft silicone extradural lead can be damaged easily by manipulations during insertion. For this reason the manufacturer modified the Tuohy needle for extradural silicone lead introduction. The disadvantages of this modified Tuohy needle are: first, difficulty in localization of the extradural space, second, the needle is unsuitable for a subarachnoid catheter or introduction of a fibreoptic scope. The Seldinger technique was performed 25 times in 18 patients, introducing a spinal silicone catheter (n = 14), an extradural silicone stimulation lead (n = 2) or a small diameter fibreoptic endoscope (n = 9). Paraesthesiae caused by neural irritation occurred in awake patients. This did not differ from the technique using a Tuohy needle only. Neural damage or trauma did not occur with the Seldinger technique. The incidence of post-spinal headache was the same for both techniques. No further complications were noted.

Animals↗