title: Spinal manipulation postepidural injection for lumbar and cervical radiculopathy: a retrospective case series.
abstract: OBJECTIVE
  To describe the safety and potential therapeutic benefit of spinal manipulation postepidural injection in the nonsurgical treatment of patients with cervical and lumbar radiculopathy.
  
  
  METHODS
  The study design was a retrospective review of outcomes of 20 cervical and 60 lumbar radiculopathy patients who underwent spinal manipulation postepidural injection in a hospital setting. Patients received either fluoroscopically guided or computed tomography (CT)-guided epidural injection of a combination of lidocaine and Depo-Medrol. The manual therapy consisted of an immediate postepidural application of flexion distraction mobilization and then high-velocity, low-amplitude spinal manipulation to the affected spinal regions. Outcome criteria were empirically defined as significant improvement, temporary improvement, or no change. The minimum follow-up time for all patients was 1 year.
  
  
  RESULTS
  There were no complications associated with spinal manipulation, whereas 3 complications associated with the epidural injection procedure were noted. Of lumbar spine patients, 36.67% (n = 22) noted significant improvement, 41.67% (n = 25) experienced temporary improvement, and 21.67% (n = 13) reported no change. Of the patients undergoing spinal manipulation after cervical epidural injection, 50% (n = 10) noted significant improvement, 30% (n = 6) experienced temporary improvement, whereas 20% (n = 4) exhibited no change.
  
  
  CONCLUSIONS
  These data suggest that spinal manipulation postepidural injection is a safe nonsurgical procedure to use in the treatment of the patient with radiculopathy of spinal origin. This is also the first report of the use of spinal manipulation postepidural injection in the cervical spine.
authors.affiliation: New York Chiropractic College, Seneca Falls, NY 13148, USA. pdougherty@nycc.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Dougherty
authors.forename: Saeed
authors.initials: S
authors.lastname: Bajwa
authors.forename: Jeanmarie
authors.initials: J
authors.lastname: Burke
authors.forename: J Donald
authors.initials: JD
authors.lastname: Dishman
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage*; D008159:Lumbar Vertebrae; D008297:Male; D026882:Manipulation, Chiropractic; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D011843:Radiculopathy / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D000077555:Methylprednisolone Acetate; D008012:Lidocaine; D008775:Methylprednisolone