Is It Safe to Adjust the Cervical Spine in the Presence of a Herniated Disc?
Donald Murphy, DC, DACAN
I am often asked by chiropractors, medical doctors and patients if manipulation of the cervical spine is safe in the presence of a cervical herniated nucleus pulposis (CHNP). I usually answer that in most circumstances it not only is safe, but it is often an essential aspect of treatment. I will clarify what this means and provide some of the evidence that supports this notion. I will also illustrate that in most of cases that require treatment, manipulation alone is not a sufficient approach, but that some form of rehabilitation is necessary.
Cervical Myelopathy:
A Case Report of a Near-Miss Complication to Cervical Manipulation
J Manipulative Physiol Ther 2008 (Sep); 31 (7): 553557
Cases have been reported in which radiculopathy or myelopathy secondary to herniated disk has occurred after cervical manipulation. In each case, it is not possible to determine whether the neurologic symptoms and signs were directly caused by the manipulation or whether they developed as part of the natural history of the disorder. The purpose of this article is to report a case in which a patient with radiculopathy secondary to herniated disk was scheduled to receive manipulation but just before receiving this treatment developed acute myelopathy.
Manipulation in the Presence of Cervical Spinal Cord Compression:
A Case Series
J Manipulative Physiol Ther 2006 (Mar); 29 (3): 236144
The finding of cervical spinal cord encroachment on magnetic resonance imaging, in and of itself, should not necessarily be considered an absolute contraindication to manipulation. However, because radicular and myelopathic complications to cervical manipulation have been reported in the literature, great care should be taken in all cases, particularly those in which anatomic conditions such as cord encroachment are present. There are more studies like this at the RADICULOPATHY Page.
Improvement of Lower Extremity Electrodiagnostic Findings Following a Trial of Spinal Manipulation and Motion-based Therapy
Chiropractic & Osteopathy 2006 (Sep 12); 14: 20 ~ FULL TEXT
An elderly male patient presented to a private spine clinic with right-sided foot drop. He had been prescribed an ankle-foot orthosis for this condition. All sensory, motor, and reflex findings in the right leg and foot were absent. This was validated on prior electromyography and nerve conduction velocity testing, performed by a board certified neurologist. Patient was treated using spinal manipulation twice-weekly and wobble chair exercises three times daily for 90 days total. Following this treatment, the patient was referred for follow-up electrodiagnostic studies. Significant improvements were made in these studies as well as self-rated daily function. There are more studies like this at the CHIROPRACTIC CASE REPORTS Page.
Chiropractic High-velocity Low-amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome
J Manipulative Physiol Ther 2004 (Nov); 27 (9): 574578
A 35-year-old woman presented with complaints of midback pain, low-back pain, buttock pain, saddle anesthesia, and bladder and bowel incontinence, all of 6 months duration. The patient was 6 months post emergency surgery for acute cauda equina syndrome due to lumbar disc herniation. She had been released from neurosurgical care with the current symptoms considered to be residual and nonprogressive. The patient was treated with high-velocity low-amplitude spinal manipulation and ancillary myofascial release. After 4 treatments, the patient reported full resolution of midback, low back, and buttock pain. The patient was seen another 4 times with no improvement in her neurologic symptoms. No adverse effects were noted.
Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations: A Systematic Review and Risk Assessment
J Manipulative Physiol Ther 2004 (Mar); 27 (3): 197210
Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH. An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.
Manipulative Therapy in Lower Back Pain With Leg Pain
and Neurological Deficit
J Manipulative Physiol Ther 1998 (May); 21 (4): 288294
The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.
Treatment of Cervical Disc Protrusions
Via Instrumental Chiropractic Adjustment
J Manipulative Physiol Ther 1998 (Feb); 21 (2): 114121
The patient was initially treated with high-velocity manual manipulation of the cervical spine and reported a subsequent aggravation of her symptoms. Thereafter, she was treated with short-lever, mechanical-force, manually-assisted chiropractic adjusting procedures to the cervical spine, utilizing an Activator Adjusting Instrument. She tolerated the treatment well and subsequently experienced a complete resolution of the presenting symptoms.
Magnetic Resonance Imaging and Clinical Follow-up: Study of 27 Patients Receiving Chiropractic Care for Cervical and Lumbar Disc Herniations
J Manipulative Physiol Ther 1996 (Nov); 19 (9): 597606
Clinically, 80% of the patients studied had a good clinical outcome with postcare visual analog scores under 2 and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. There was a statistically significant association (p < .005) between the clinical and MRI follow-up results. Seventy-eight percent of the patients were able to return to work in their predisability occupations.
Chiropractic Treatment of Cervical Radiculopathy Caused by
a Herniated Cervical Disc
J Manipulative Physiol Ther 1994 (Feb); 17 (2): 119123
Conservative treatment including chiropractic manipulative therapy seems to be a reasonable alternative to surgery, for cervical radiculopathy caused by a herniated cervical disc. Clinical trials should be performed to evaluate long term success rate, risk of permanent disability, rate of recovery and cost effectiveness of this and other forms of treatment for cervical radiculopathy caused by herniated nucleus pulposus.findings.
Chiropractic Management and Manipulative Therapy for MRI Documented Cervical Disk Herniation
J Manipulative Physiol Ther 1994 (Mar); 17 (3): 177185
The patients were prescribed a treatment regimen consisting of chiropractic management including bracing, physiotherapy, cervical manipulative procedures, traction and exercises. The patients responded well to care as evidence by posttreatment MRI, electrodiagnostic studies, clinical exam findings and thermography scan findings. Patients with and without nerve root compression secondary to cervical disk herniation can and do respond well to chiropractic care. Chiropractic management of this condition can and should be employed prior to more invasive treatment.
